Intensity of anticoagulation in the treatment of thrombosis in the antiphospholipid syndrome: a meta-analysis

Abstract

RBRE-155; No. of Pages 8 r e v b r a s r e u m a t o l . 2 0 1 5;x x x(x x):xxx-xxx REVISTA BRASILEIRA DE REUMATOLOGIA w w w . r e u m a t o l o g i a . c o m . b r Thrombosis Hemorrhage Warfarin a b s t r a c t Introduction: Discussion about the intensity of warfarin in patients with antiphospholipid syndrome (APS) remains present in our days. Objectives: To evaluate which intensity of anticoagulation with warfarin is associated with a greater reduction of thromboembolic events in the treatment of patients with APS, as well as assess the risk of bleeding in the different treatment modalities. Methodology: A systematic review of the literature was carried out with search from electronic databases: PubMed, LILACS and SciELO, with the use of the key-words: treatment, warfarin, antiphospholipid syndrome, antiphospholipid antibody syndrome and their respective translations into Portuguese, in different combinations. In addition, a meta-analysis with the aid of Review Manager 5.2 software by Cochrane was performed. Results: Only two articles met the inclusion criteria for this study. Regarding the main outcome assessed in this study, the two studies showed similar values, indicating higher frequency of thrombotic events in high-intensity groups. The comparative analysis of the randomized clinical trial evaluated showed an increased thrombotic risk for those patients who received intervention with high-intensity warfarin. Another finding of the metaanalysis was the higher incidence of minor bleeding, also in the experimental group, that received warfarin keeping International Normalized Ratio (INR) > 3. Conclusion: In individuals with APS and prevalence of venous events, the use of moderate intensity (MI) anticoagulation (INR: 2-3) is the most suitable. However, this evidence cannot yet be extended to patients with arterial events, due to the limited representation of this sample of subjects in the two clinical trials included in this meta-analysis. RBRE-155; No. of Pages 8 2 r e v b r a s r e u m a t o l . 2 0 1 5;x x x(x x):xxx-xxx Intensidade da anticoagulação no tratamento da trombose na síndrome antifosfolípide: meta-análisePalavras-chave: Síndrome antifosfolípide Trombose Hemorragia Varfarina r e s u m o Introdução: a discussão sobre a intensidade de varfarina em pacientes com síndrome antifosfolípide (SAF) permanece presente nos dias atuais. Objetivos: avaliar qual intensidade de anticoagulação com varfarina está associada com maior redução de eventos tromboembólicos no tratamento de pacientes com SAF, assim como avaliar o risco de hemorragia nas diferentes modalidades de tratamento. Metodologia: foi realizada uma revisão sistemática da literatura a partir de busca nas bases de dados eletrônicos: PubMed, LILACS e SciELO, sendo utilizadas as palavras-chave: treatment, warfarin, antiphospholipid syndrome, antiphospholipid antibody syndrome e suas respectivas traduç ões para o português, em diferentes combinaç ões. Também foi realizada uma metaanálise com auxílio do programa Review Manager 5.2 da Cochrane. Resultad...

Direct oral anticoagulants: an alternative treatment for thrombotic antiphospholipid syndrome?

“…2 Currently, it is recommended that a target international normalized ratio (INR) of 2.5 (range, 2–3) is maintained for an indefinite period following the first episode of venous thromboembolism, 3,4 although in patients with APS with recurrent thrombosis or arterial thrombosis, the optimal intensity of anticoagulation is an issue of debate. 5 Direct oral anticoagulants (DOACs) represent an attractive therapeutic option. These pharmacological compounds directly inhibit a single enzyme in the coagulation cascade.…”

Associated factors and safety of the rapidly achieving first therapeutic target of warfarin in hospitalized patients: a retrospective cohort study

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Prevalência De Incontinência Urinária Em Idosos No Brasil Nos Últimos 10 Anos: Uma Revisão Sistemática

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