title: Antiphospholipid syndrome and anticoagulation quality: a clinical challenge.
abstract: OBJECTIVE
  Antiphospholipid Syndrome (APS) is often complicated by ischemic vascular events. Vitamin K Antagonists (VKAs) reduce the risk of recurrent thrombosis. Quality of VKAs treatment, as assessed by the Time in Therapeutic Range (TTR), has never been investigated in APS patients.
  
  
  METHODS
  We performed a prospective observational study including 30 APS and 30 Atrial Fibrillation (AF) patients balanced by age and gender. All patients were treated with VKAs (INR target 2.5), and TTR was calculated.
  
  
  RESULTS
  Median TTR of APS was 53.5% vs. 68% of AF patients (p = 0.001). A multivariable linear regression analysis confirmed that the presence of APS (vs. AF) was independently associated with a worse TTR (B: -14.067, 95% Confidence Interval -25.868/-2.266, p = 0.020). The weekly dosage of VKAs was significantly higher in APS than AF patients.
  
  
  CONCLUSIONS
  APS patients disclose a lower quality of anticoagulation compared to those with AF, requiring higher doses of VKAs. The efficacy of non-vitamin K oral anticoagulants in this high-risk patients should be tested.
authors.affiliation: I Clinica Medica, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Pastori
authors.affiliation: I Clinica Medica, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Parrotto
authors.affiliation: I Clinica Medica, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Tommasa
authors.initials: T
authors.lastname: Vicario
authors.affiliation: I Clinica Medica, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Mirella
authors.initials: M
authors.lastname: Saliola
authors.affiliation: Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Mezzaroma
authors.affiliation: I Clinica Medica, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
authors.affiliation: I Clinica Medica, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Rome, Italy. Electronic address: pasquale.pignatelli@uniroma1.it.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pignatelli
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D001777:Blood Coagulation / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care; D012008:Recurrence; D013927:Thrombosis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Antiphospholipid syndrome; Time in therapeutic range; Warfarin