Anticardiolipin antibodies predict early recurrence of thromboembolism and death among patients with venous thromboembolism following anticoagulant therapy
Anticardiolipin antibodies predict early recurrence of thromboembolism and death among patients with venous thromboembolism following anticoagulant therapy
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DOI：
10.1016/s0002-9343(98)00060-6
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发表时间：
1998-04-01
影响因子：
5.9
通讯作者：
Granqvist, S
中科院分区：
文献类型：
--
作者：
Schulman, S;Svenungsson, E;Granqvist, S
目的：比较有和没有抗磷脂抗体的患者复发静脉血栓栓塞的风险。患者和方法：在第一次或第二次静脉血栓栓塞发作后 6 个月检测抗心磷脂抗体。在首次发生静脉血栓栓塞的患者中，仅对 412 名接受 6 个月抗凝治疗的患者进行了研究。 211 名第二次发作的患者接受了 6 个月或无限期口服抗凝治疗。该疗法的目标是国际标准化比率 (INR) 为 2.0 至 2.85。 FLU患者入组后随访4年。结果：在412名首次发生静脉血栓栓塞的患者中，有抗心磷脂抗体的患者复发风险为29%，无抗体的患者复发风险为14%（P = 0.0013）。对于具有抗体的患者，停止抗凝治疗后的前 6 个月内风险会增加。复发的风险随着抗体滴度的增加而增加。具有抗体的患者的四年死亡率为 15%，无抗体的患者的四年死亡率为 6%（P = 0.01）。在 34 名第二次发生静脉血栓栓塞和抗心磷脂抗体的患者中，抗凝治疗期间没有复发，而仅接受 6 个月治疗的患者复发率为 20% (P = 0.08)。结论：静脉血栓栓塞发作后 6 个月出现抗心磷脂抗体滴度升高是复发和死亡风险增加的预测因子。患有抗心磷脂抗体和静脉血栓栓塞的患者似乎受益于长期口服抗凝治疗。 (C) 1998 年，Excerpta Medica, Inc.
PURPOSE: To compare the risk of recurrent venous thromboembolism in patients with and without antiphospholipid antibodies.PATIENTS AND METHODS: Anticardiolipin antibodies were tested 6 months after a first or second episode of venous thromboembolism. Of the patients with a first episode of venous thromboembolism only the 412 who received 6 months of anticoagulation were studied. Two hundred and eleven patients with a second episode received oral anticoagulation for 6 months or indefinitely. The therapy was targeted at an international normalized ratio (INR) of 2.0 to 2.85. FLU patients were followed up for 4 years after enrollment.RESULTS: Among the 412 patients with a first episode of venous thromboembolism the risk of recurrence was 29% in patients with anticardiolipin antibodies and 14%, in those without antibodies (P = 0.0013). In those with antibodies, there was an increased risk during the first 6 months after cessation of anticoagulation. The risk of recurrence increased with the titer of the antibodies. Four-year mortality rate was 15% in those with antibodies and 6% in those without (P = 0.01). Among 34 patients with a second event of venous thromboembolism and anticardiolipin antibodies, there were no recurrences during anticoagulant therapy versus 20% in those who received only 6 months of treatment (P = 0.08).CONCLUSIONS: The presence of elevated titers of anticardiolipin antibodies 6 months after an episode of venous thromboembolism is a predictor for an increased risk of recurrence and of death. Patients with anticardiolipin antibodies and venous thromboembolism seem to benefit from prolonged oral anticoagulation. (C) 1998 by Excerpta Medica, Inc.