Which antithrombotic regimen is most appropriate for apatient with systemic lupus erythematosus and anticardiolipinantibody syndrome who has had a previous infarct?
Which antithrombotic regimen is most appropriate for apatient with systemic lupus erythematosus and anticardiolipinantibody syndrome who has had a previous infarct?-- MD
Antiphospholipid-antibody syndrome is characterizedby the presence of antibodies directedagainst phospholipids and by clinical thrombosis.Clinical features associated with the syndromeinclude:
The most clinically relevant antibodies are thosedirected against cardiolipin (anticardiolipin antibodies),β
-glycoprotein I (anti-β
-glycoprotein I antibodies), anda lupus anticoagulant (antibodies that cause in vitro prolongationof clotting tests, such as Russell viper venomtime, activated partial thromboplastin time, and kaolinclotting time). In patients with these antibodies who havehad a major clotting event (eg, deep venous thrombosis/pulmonary embolism, myocardial infarction, or cerebralvascular accident), lifelong warfarin therapy--with a targetINR of 3 or higher--is recommended.
Among thosepatients who do not receive anticoagulant therapy, a 30%incidence of recurrent thrombosis has been reported.
Some clinicians advocate discontinuation of anticoagulationif the results of tests for antiphospholipid antibodiesbecome negative; however, this is a minority opinion.
-- Bonnie Lee Bermas, MD
Assistant Professor of Medicine
Division of Rheumatology
Harvard Medical School
McCrae KR. Antiphospholipid antibody-associated thrombosis: a consensusfor treatment?
Lockshin MD. Answers to the antiphospholipid-antibody syndrome?
N EnglJ Med.
Khamashta MA, Cuadrado MJ, Mujic F, et al. The management of thrombosisin the antiphospholipid-antibody syndrome.
N Engl J Med.