In 2002, we performed a retrospective analysis during the course of 1 yr for 66 patients with definite APS according to the Sapporo criteria-i.e. The intensity of oral anticoagulation was measured in a minority of patients, thus not providing relevant data on their different efficacies. The difference was statistically significant, however, between untreated patients (0.192 events per patient-yr) and those receiving warfarin (0.051 events per patient-yr), with a resulting relative risk of 0.26 (95% CI 0.11–0.64). Aspirin decreased arterial events as compared with untreated patients, although statistical significance was not reached (relative risk 0.43 95% CI 0.13–1.37). These authors analysed the influence of treatment on the rate of recurrent arterial and venous thrombosis. Medium to high titres of aCL and/or LA were required for the diagnosis of APS. Thirty eight patients (62%) had presented with arterial events. published a retrospective review of 61 patients with APS. patients aimed to a target International Normalized Ratio (INR) ≥3.0 had a significantly lower risk of recurrent thrombosis than those aimed at less intense anticoagulation. found a dose-related effect of oral anticoagulation, i.e. Further, the studies by Rosove and Brewer and Khamashta et al. It is notable that the highest risk period for thrombosis was 6 months after stopping anticoagulation. The risk of recurrent events was higher in those who were untreated or given aspirin alone than in those receiving warfarin. These two studies suggested the need for prolonged anticoagulation in APS patients with thrombosis. Repeated medium to high titres of aCL and/or LA were needed for inclusion in the study. analysed 147 patients with venous (54%) or arterial thrombosis (46%). Repeated positivity or medium to high titres of aCL was not a requirement for entering the study however, only 17% of patients had low-titre aCL. Rosove and Brewer studied 70 patients with thrombosis (44% arterial) and aCL and/or lupus anticoagulant (LA). While stroke was recognized as a major feature of the syndrome in the earliest descriptions, the first therapeutic data to come from retrospective studies were published between 19.
#COUMADIN ANTI STROKE SERIES#
Fortunately, two prospective controlled studies and a small prospective case series have been published in recent months. Until recently, only retrospective studies were available, with the resulting risk of bias and a high degree of uncertainty. ĭata on the therapeutic approach to stroke in patients with APS are scarce. Thus it is not surprising that an important debate follows the search for the optimal treatment of stroke in APS.
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#COUMADIN ANTI STROKE FREE#
On the other hand, antiaggregant and anticoagulant therapy are not free from serious side-effects. Thus, preventing recurrent thrombotic stroke is one of the main therapeutic goals in APS.
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Cerebrovascular disease carries high mortality and morbidity, with important and often disabling sequelae. The cerebral circulation is particularly affected in APS. Patients with aPL have been shown to be at a higher risk of recurrent thrombotic events in prospective studies, both at the venous and arterial level. This syndrome was described in great clinical detail in the early 1980s and is nowadays considered to be one of the most frequent acquired thrombophilias. Due to the often devastating consequences of stroke, we believe there is a place for prolonged, high-intensity anticoagulation in patients with APS and cerebral arterial thrombosis.Īntiphospholipid syndrome (APS) is defined by the development of thrombosis and/or adverse obstetric events in the presence of antiphospholipid antibodies (aPL). While future investigation must better define homogeneous subsets of patients with APS, current secondary prophylaxis of thrombosis in these patients must be tailored according to individual estimated risk of recurrences, risk of haemorrhage and severity of potential recurrent events. In addition to the obvious differences in design, other factors such as the important variability in the study groups account for the discrepancy.
#COUMADIN ANTI STROKE FULL#
However, results from prospective and retrospective studies are not in full agreement. Recently, three prospective studies (two controlled and one uncontrolled small series) have addressed the role of antiaggregant and anticoagulant therapy in patients with stroke and aPL. Recommendations for treatment of APS have long been based on studies with a retrospective design. Although it is difficult to predict which patients with antiphospholipid antibodies (aPL) will develop thrombosis, once a thrombotic event has taken place, secondary prevention is mandatory. Thromboses can be at both the venous and arterial level, are usually recurrent and frequently affect cerebral circulation. Antiphospholipid syndrome (APS) is one of the most frequent acquired thrombophilias.