Anticardiolipin Antibodies and Recurrent Thromboembolism

Abstract

We read with interest the letter from Prandoni et al. (1) reporting the high risk of thromboembolic recurrence after interruption of oral anticoagulants in patients with antiphospholipid antibodies suffering a first episode of venous thrombosis. The authors obtained these results in patients with lupus anticoagulant alone, and in patients with both lupus anticoagulant and anticardiolipin antibodies. We have found similar results in patients with anticardiolipin antibodies alone suffering an episode of venous thromboembolism. From 1991 to 1994, 204 consecutive patients were hospitalized in our department for deep venous thrombosis (proved by echoDoppler or phlebography) or pulmonary embolism (proved by lung scan or pulmonary angiography). Lupus anticoagulant (LA) and anticardiolipin antibodies (ACLA) were tested for 153 patients. Of these, 6 (3.9%) had LA alone, 3 (1.9%) had both LA and ACLA (one also had factor V Leiden) and 18 (1 1%) had ACLA alone (ELISA assay above 7 UGPL, normal values below 7 UGPL). One of these 18 patients had also factor V Leiden. None of these patients had systemic lupus erythematosus. After exclusion of one patient with isolated LA and one patient with both LA and ACLA because of a history of cancer, the remaining 151 patients were followed prospectively for 1 to 4years (mean 27 months). All patients were treated with heparin followed by fluindione for three to six months (targeted IN : 2-3). Three patients in the ACLA group, 2 in the group with both LA and ACLA, 1 in the LA group and 19 in the control group had long-term oral anticoagulation for recurrent deep venous thrombosis or atrial fibrillation. Six patients

Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature

“…As shown in Table 1, at least 10 different screening and confirmatory assays were used either alone or in various combinations to detect lupus anticoagulants. Three studies 26,32,36 did not provide enough information about the laboratory methods used to diagnose lupus anticoagulants. Three studies 32,34,36 did not give laboratory details about anticardiolipin antibody detection.…”

American Heart Association/American College of Cardiology Foundation Guide to Warfarin Therapy

“…207,209 These recommendations are based on results of randomized trials 207 that demonstrated that oral anticoagulants effectively prevent recurrent venous thrombosis (risk reduction Ͼ90%), that treatment for 6 months is more effective than treatment for 6 weeks, 206 and that treatment for 2 years is more effective than treatment for 3 months. 208 …”

Thrombus on the Tricuspid Valve in a Patient With Primary Antiphospholipid Syndrome After Implantation of an Inferior Vena Cave Filter.

“…There is a high risk of recurrence after discontinuation of oral anticoagulant therapy, [19][20][21][22][23] and in the present patient pulmonary embolism recurred 10 months after cessation of warfarin. Therefore, long-term anticoagulant therapy is thought to be necessary.…”

“…Lifelong treatment with oral anticoagulants with a target INR of 3.0 or more has been recommended, based on data from 3 retrospective studies, 19 but several recent reports have suggested that many patients with APS can be treated with conventional doses of warfarin. [21][22][23]25 The risk of high-intensity anticoagulant therapy in patients with APS has also been reported. 26 The present patient's course has been uneventful for 14 months on a target INR of 2.0-2.5 after the most recent episode.…”