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Antiphospholipid antibodies and venous thromboembolism
JS Ginsberg, PS Wells, P Brill-Edwards, D Donovan, K Moffatt, M Johnston, P Stevens and J Hirsh
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
The clinical relevance of antiphospholipid antibodies (APLA) in patients
without systemic lupus erythematosus who have venous thromboembolism (VTE)
in unknown. Limited evidence suggests that there is an association between
the presence of APLA and both initial and recurrent episodes of VTE and
that patients with APLA and VTE are resistant to warfarin therapy.
Unselected patients with a first episode of clinically suspected deep vein
thrombosis or pulmonary embolism were evaluated with objective tests for
VTE and with laboratory tests for APLA; the latter included tests for the
lupus anticoagulant (LA) and anticardiolipin antibodies (ACLA). Patients
with VTE were treated with anticoagulant therapy and observed during and
after discontinuation of anticoagulants for symptomatic recurrence of VTE.
There was a strong association between LA and VTE (odds ratio, 9.4; 95%
confidence interval [CI], 2.1 to 46.2) and 9 to 65 (14%; 95% CI, 7% to 25%)
patients with VTE had LA. There was no association between the presence of
ACLA and VTE (odds ratio, 0.7; 95%CI, 0.3 to 1.7) because of the high
frequency of positive ACLA assays in patients without VTE. None of the 16
patients with VTE and APLA developed recurrent VTE while receiving warfarin
therapy. There was no difference in rates of recurrent VTE in patients with
or without APLA after anticoagulant therapy was discontinued. The strong
association between LA and VTE suggests that testing for LA in patients
with VTE is useful. The measurement of ACLA in patients with VTE has no
clinical usefulness because the results are abnormal in a high proportion
of patients without VTE. Although the presence of APLA in patients with VTE
was not associated with resistance to a conventional intensity of warfarin
or an increased risk of recurrent VTE after discontinuation of warfarin, a
larger study should address these issues in a subgroup of patients with VTE
and LA.
Volume 86,
Issue 10,
pp. 3685-3691,
11/15/1995
Copyright © 1995 by The American Society of Hematology
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