REVIEW - A systematic review of secondary thromboprophylaxis in patients with antiphospholipid antibodies

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Arthritis Rheum. 2007 Dec 15;57(8):1487-95.

A systematic review of secondary thromboprophylaxis in patients with

antiphospholipid antibodies.

Ruiz-Irastorza G, Hunt BJ, Khamashta MA.

Hospital de Cruces, and University of the Basque Country, Bizkaia, Spain.

OBJECTIVE: To systematically review the efficacy and safety data of

different therapeutic approaches in patients with antiphospholipid

antibodies (aPL) and thrombosis. METHODS: The Medline database and

references from selected reports and review articles were used.

Randomized controlled trials, prospective and retrospective cohort

studies, and subgroup analysis (n > 15) that focused on the secondary

thromboprophylaxis in patients with aPL were selected. RESULTS:

Sixteen studies were selected. Patients with venous events and a

single test for aPL showed a low recurrence rate while receiving oral

anticoagulation at a target international normalized ratio (INR) of

2.0-3.0. Patients with stroke and a single positive aPL test had no

increased risk compared with those without aPL. Recurrence rates in

patients with definite antiphospholipid syndrome (APS) and previous

venous thromboembolism were lower than in patients with arterial

and/or recurrent events, both with and without therapy. Only 3.8% of

recurrent events occurred at an actual INR >3.0. Mortality due to

recurrent thrombosis was higher than mortality due to bleeding (18

patients versus 1 patient reported). CONCLUSION: For patients with

definite APS, we recommend prolonged warfarin therapy at a target INR

of 2.0-3.0 in APS patients with first venous events and >3.0 for those

with recurrent and/or arterial events. For patients with venous

thromboembolism or stroke and a single positive aPL test, we recommend

further testing to determine if they have a persisting antibody. If

they do not, the same therapy as for the general population should be

used (warfarin at a target INR of 2.0-3.0 and low-dose aspirin,

respectively).

PMID: 18050167

http://www.ncbi.nlm.nih.gov/pubmed/18050167

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