Clot Prevention in Patients With Anticardiolipin Antibody Syndrome

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:

• Arterial and/or venous clots.
• Pregnancy loss.
• Migraine.
• Raynaud phenomenon.
• Thrombocytopenia.

The most clinically relevant antibodies are thosedirected against cardiolipin (anticardiolipin antibodies),β

₂

-glycoprotein I (anti-β

₂

-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.

^1,2

Among thosepatients who do not receive anticoagulant therapy, a 30%incidence of recurrent thrombosis has been reported.

³

Some clinicians advocate discontinuation of anticoagulationif the results of tests for antiphospholipid antibodiesbecome negative; however, this is a minority opinion.

¹

-- Bonnie Lee Bermas, MD
  &nbsp Assistant Professor of Medicine
  &nbsp Division of Rheumatology
  &nbsp Harvard Medical School
  &nbsp Boston

References:

REFERENCES:1.

McCrae KR. Antiphospholipid antibody-associated thrombosis: a consensusfor treatment?

Lupus.

1996;5:560-570.

2.

Lockshin MD. Answers to the antiphospholipid-antibody syndrome?

N EnglJ Med.

1995;332:1025.

3.

Khamashta MA, Cuadrado MJ, Mujic F, et al. The management of thrombosisin the antiphospholipid-antibody syndrome.

N Engl J Med.

1995;332:993-997.