High intensity anticoagulation in the prevention of the recurrence of arterial thrombosis in antiphospholipid syndrome: 'PROS' and 'CONS'.
The use of high intensity anticoagulation in the prevention of recurrence of arterial thrombosis related to the Antiphospholipid Syndrome (APS) is still controversial. This paper reports a debate that took place at the CORA meeting (Controversies in Rheumatology and Autoimmunity), held in Florence in March 2011. Major points of discussion were: 1) the paucity of prospective randomized clinical trials; retrospective studies were the main source supporting the use of high intensity anticoagulation; 2) heterogeneity in antiphospholipid antibodies (aPL) definition, due to the lack of standardization of aPL assays and to the failure to distinguish patients with a high risk profile ("triple positive") from those a low risk profile; 3) bleeding is a major concern about high intensity anticoagulation; however, studies are not concordant in reporting an increased risk compared to the standard regimen; 4) practical issues consist of difficulties in keeping a stable PT-INR over 3 and the possibility for interference by aPL on the thromboplastins used for PT-INR measurement. In conclusion, there is currently a lack of consensus on the use of high intensity anticoagulation for the secondary prophylaxis of arterial thrombosis. However, such a treatment may be particularly recommended in those APS patients who have a high risk aPL profile and other concomitant cardiovascular risk factors, provided that the potential benefit outweighs the risk of bleeding.
Clinical Cardiology, Thrombosis Centre, University Hospital, Padova, Italy.
Vittorio
V
Pengo
Guillermo
G
Ruiz-Irastorza
Gentian
G
Denas
Laura
L
Andreoli
Munther
M
Khamashta
Angela
A
Tincani
D000818:Animals; D017152:Antibodies, Antiphospholipid / Q000276:immunology; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D001158:Arteries / Q000473:pathology; D002985:Clinical Protocols; D003245:Consensus Statements as Topic; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D013925:Thromboplastin / Q000378:metabolism; D013927:Thrombosis / Q000097:blood / Q000276:immunology / Q000517:prevention & control*
D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D013925:Thromboplastin