title: Hemorrhagic complications of long-term anticoagulant therapy in 7 patients with systemic lupus erythematosus and antiphospholipid syndrome.
abstract: OBJECTIVE
  To describe the presentation, course, and management of serious hemorrhagic complications of anticoagulant therapy for patients with antiphospholipid syndrome (APS).
  
  
  METHODS
  Charts of patients identified with serious bleeding complications from anticoagulation for APS were reviewed.
  
  
  RESULTS
  Patients included 6 women and one man with systemic lupus erythematosus (SLE) and one woman with primary APS. One patient had 3 separate hemorrhagic events. There were 6 episodes of subdural hematoma in 5 patients, one episode of pericarditis with tamponade, one episode of hemoptysis, and one episode of ovarian hemorrhage. In 2 patients, symptoms related to hemorrhage were initially attributed to active SLE. Duration of anticoagulation was between one month and 10 years at the time of bleed. International normalized ratio (INR) and prothrombin time were above the intended range in 6/9 episodes. There were no deaths and no permanent sequelae due to bleeding. Anticoagulant therapy was resumed in 6/7 patients.
  
  
  CONCLUSIONS
  The management of APS must include vigilance, patient education, and anticoagulation to maintain the INR between 3 and 3.5. To prevent hemorrhagic complications, low molecular weight heparin is an option that deserves further study.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: F A
authors.initials: FA
authors.lastname: al-Sayegh
authors.forename: S
authors.initials: S
authors.lastname: Ensworth
authors.forename: S
authors.initials: S
authors.lastname: Huang
authors.forename: H B
authors.initials: HB
authors.lastname: Stein
authors.forename: A V
authors.initials: AV
authors.lastname: Klinkhoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000188:drug therapy*; D017809:Fatal Outcome; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D016682:Lupus Coagulation Inhibitor; D014859:Warfarin