Bleeding and recurrent thrombosis in definite antiphospholipid syndrome: analysis of a series of 66 patients treated with oral anticoagulation to a target international normalized ratio of 3.5.
Bleeding and recurrent thrombosis in definite antiphospholipid syndrome: analysis of a series of 66 patients treated with oral anticoagulation to a target international normalized ratio of 3.5.
复制标题
明确的抗磷脂综合征中的出血和复发性血栓形成：对 66 名接受口服抗凝治疗的患者进行的一系列分析，目标国际标准化比率为 3.5。
作者：
G. Ruiz‐Irastorza;M. Khamashta;B. Hunt;A. Escudero;M. Cuadrado;G. Hughes
背景
长期抗凝治疗是血栓形成和抗磷脂综合征患者的首选治疗方法。然而，关于最佳抗凝强度仍存在争议。
方法
该研究包括 66 名患有抗磷脂综合征（札幌标准）且既往患有血栓的患者。所有患者均接受口服抗凝治疗，目标国际标准化比率为 3.5。每一位患者都接受了单独访谈，以回忆过去 12 个月内的大出血和血栓形成事件。
结果
患者主要是女性和白人。大出血率为每 100 患者年 6 例（95% 置信区间 [CI] 1.6-15.0）。颅内出血率为每 100 患者年 1.5 例（95% CI，0.04-8.4）。没有一次出血事件是致命的。血栓复发率为每 100 患者年 9.1 例（95% CI，3.3-19.6）。大多数复发发生在与原始血栓形成相同的血管床中。年龄、接受抗凝治疗的时间、原发性与继发性抗磷脂综合征、抗心磷脂抗体阳性、狼疮抗凝物阳性、既往动脉血栓形成、既往中风、既往静脉血栓形成和既往血小板减少症不能预测出血事件。然而，接受较长时间抗凝治疗的患者血栓复发的风险独立较高。
结论
患有明确抗磷脂综合征且既往有血栓形成且接受口服抗凝治疗至国际标准化目标比率 3.5 的患者的颅内和致命出血风险与接受较低目标比率治疗的患者组相似。即使在抗凝治疗期间，血栓复发的风险也很高。大多数复发发生在与原始血栓相同的区域。
BACKGROUND
Prolonged anticoagulation is the treatment of choice for patients with thrombosis and the antiphospholipid syndrome. However, there is still debate about the optimum intensity of anticoagulation.
METHODS
The study included 66 patients with antiphospholipid syndrome (Sapporo criteria) and previous thrombosis. All were receiving oral anticoagulation to a target international normalized ratio of 3.5. Every patient was individually interviewed to recall major bleeding and thrombotic episodes during the previous 12 months.
RESULTS
Patients were mainly women and white. The rate of major bleeding was 6 cases per 100 patient-years (95% confidence interval [CI] 1.6-15.0). The rate of intracranial bleed was 1.5 per 100 patient-years (95% CI, 0.04-8.4). None of the bleeding episodes was fatal. The rate of thrombotic recurrences was 9.1 cases per 100 patient-years (95% CI, 3.3-19.6). Most recurrences took place in the same vascular bed as the original thrombosis. Age, time receiving anticoagulant therapy, primary vs secondary antiphospholipid syndrome, positivity for anticardiolipin antibodies, positivity for lupus anticoagulant, previous arterial thrombosis, previous stroke, previous venous thrombosis, and previous thrombocytopenia were not predictive of bleeding events. However, the risk of thrombotic recurrences was independently higher in patients who were receiving anticoagulation for longer periods.
CONCLUSIONS
The risk of intracranial and fatal bleeding in patients with definite antiphospholipid syndrome and previous thrombosis treated with oral anticoagulation to a target international normalized ratio of 3.5 is similar than in groups of patients treated to lower target ratios. The risk of thrombotic recurrences, even during anticoagulation, was high. Most recurrences took place in the same territory as original thromboses.
房颤患者抗血栓治疗期间的出血。
影响因子：
--
作者：
通讯作者：
--