title: Efficacy and safety of long-term low molecular weight heparin in patients with antiphospholipid syndrome.
abstract: OBJECTIVE
  Evaluation of the effectiveness and safety of long-term low molecular weight heparin (LMWH) in patients with antiphospholipid syndrome (APS) that had not previously responded to or tolerated oral vitamin K antagonists.
  
  
  METHODS
  23 patients with confirmed diagnosis of APS were retrospectively recruited. All patients were receiving LMWH as a result of intolerance and/or lack of response to warfarin therapy. The type of LMWH, the duration of treatment, the reason for switching to LMWH and the adverse effects were recorded. Outcomes were classified as no improvement, partial improvement or total improvement after at least 1 year of using LMWH.
  
  
  RESULTS
  The average duration of LMWH treatment was 36 months. Most of the patients were on treatment with enoxaparin (n=16, 69%) and were switched to LMWH from warfarin mainly because of thrombosis despite therapeutic international normalised ratio (n=9, 39%). Good quality of life with no evidence of recurrent thrombotic events was noted in nine patients (39%), whereas 11 (48%) showed partial clinical improvement but no evidence of recurrent thrombotic episodes. Osteoporosis was reported in five patients (23%), all of whom were also receiving treatment with corticosteroids.
  
  
  CONCLUSIONS
  Long-term LMWH may be a safe and effective alternative to warfarin for APS patients.
authors.affiliation: Systemic Autoimmune Diseases Unit, Internal Medicine Department, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Vargas-Hitos
authors.forename: Oier
authors.initials: O
authors.lastname: Ateka-Barrutia
authors.forename: Shirish
authors.initials: S
authors.lastname: Sangle
authors.forename: Munther A
authors.initials: MA
authors.lastname: Khamashta
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004341:Drug Evaluation / Q000379:methods; D057915:Drug Substitution; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000517:prevention & control; D017211:Treatment Failure; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin