[Premature cardiovascular disease: no indication for the determination of antiphospholipid antibodies or lupus anticoagulant as a possible risk factor].
In patients with premature atherothrombotic disease, the antiphospholipid syndrome (APS, defined as any thrombosis plus the repeated presence ofantiphospholipid antibodies) is sometimes looked for, as observational studies have suggested a link between APS and premature atherothrombosis. However, recent reviews that evaluated the prognostic value of antiphospholipid antibodies have concluded that the prognostic significance ofAPS for recurrent thrombotic disease is, at best, unclear and that its presence has no therapeutic consequences. A study that compared high- versus standard-dosage warfarin in patients with APS found no additional benefit from high-dosage warfarin. A study in patients with a recent ischaemic stroke found no additional benefit from warfarin (standard dosage) versus aspirin in patients with or without antiphospholipid antibodies. Therefore, on the basis of the evidence at hand, screening for APS in patients with premature atherosclerosis is not considered to be useful.
Wierema
T K A
TK
Academisch Ziekenhuis Maastricht, Postbus 5800, 6202 AZ Maastricht. Afd. Vasculaire Geneeskunde. twie@sint.azm.nl
Stehouwer
C D A
CD
D017152:Antibodies, Antiphospholipid / Q000097:blood*; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood*; D011379:Prognosis; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis* / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use
D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D015415:Biomarkers; D016682:Lupus Coagulation Inhibitor; D014859:Warfarin