title: Bleeding and re-thrombosis in primary antiphospholipid syndrome on oral anticoagulation: an 8-year longitudinal comparison with mitral valve replacement and inherited thrombophilia.
abstract: The aim of this study was to compare bleeding and re-thrombosis in primary antiphospholipid syndrome (PAPS), mitral valve replacement (MVR) and inherited thrombophilia (IT) at different oral anticoagulation intensities. It entailed a prospective 8-year follow-up on 67 patients with PAPS, 89 with IT and 24 with MVR. Anticardiolipin (aCL) antibodies detected by Elisa and lupus anticoagulant by clotting assays. At INR 2-3 minor bleeding rate was higher in MVR (33.3) than PAPS (10.9) and IT (4.2)(p<0.0001). At INR 3-4 minor bleeding rate was higher in PAPS (142) than IT (33.3) and MVR (5.8)(p<0.0001). At either INR major bleeding rate were not significantly different across the three groups, but in PAPS major and minor bleeding rates were superior at INR 3-4 than INR 2-3 (p=0.02 and p<0.0001). Re-thrombosis rate was higher in PAPS than IT at INR 2-3 (4.0 vs 0.35) (p=0.01) and at INR 3-4 (10.5 vs. nil). The hazard ratio for re-thrombosis between PAPS and IT was 13 (95% IC 1.6-102.2, p=0.015). By regression analysis, baseline IgG aCL titre (>80 GPL) p=0.001) and male sex (p=0.03) independently predicted re-thrombosis. In conclusion, in PAPS, high intensity oral anticoagulation was not superior to conventional intensity in preventing re-thrombosis but was offset by greater bleeding rates. Male sex and elevated baseline IgG aCL predicted rethrombosis in PAPS that is 13-fold more re-thrombogenic than IT.
authors.affiliation: Leeds University Teaching Hospitals, Rheumatology, Leeds, UK. paxmes@aol.com
authors.forename: Paul R J
authors.initials: PR
authors.lastname: Ames
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciampa
authors.forename: Maurizio
authors.initials: M
authors.lastname: Margaglione
authors.forename: Giovanna
authors.initials: G
authors.lastname: Scenna
authors.forename: Luigi
authors.initials: L
authors.lastname: Iannaccone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Brancaccio
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005192:Family Health; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011237:Predictive Value of Tests; D012008:Recurrence; D019851:Thrombophilia / Q000150:complications* / Q000235:genetics; D013927:Thrombosis / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants