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Long-term Warfarin Effective in Preventing Catastrophic Antiphospholipid Syndrome Reoccurrence
A DGReview of :"Long term outcome of catastrophic antiphospholipid syndrome survivors"
Annals of the Rheumatic Diseases (ARD Online)
06/04/2003
By Jill Taylor
Up to 66% of survivors of an initial catastrophic antiphospholipid syndrome (APS) event remain symptom-free for several years with anticoagulation therapy, according to a new long-term study.
Catastrophic APS, a rapid development of multiple organ system thromboses, is associated with a mortality rate of approximately 50%. The prognosis for survivors over time is largely unknown.
"This is the first study demonstrating that catastrophic APS recurrence is unusual and patients treated with anticoagulation generally have a stable course," the researchers said.
Building on previous studies concerning clinical characteristics and outcomes of 130 APS patients, Dr. D. Erkan of the Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, United States, and colleagues made follow up inquiries to determine the mode of therapy following the initial APS event and whether patients experienced further APS episodes or thrombosis.
Approximately 46% of the original 130 APS patients died at the time of the initial event. Additional information was available for 58 patients surviving the initial APS event, and these patients comprised the study population.
Researchers found warfarin the predominant drug of choice for anticoagulation. Thirty-eight patients experienced no further APS-related complications with anticoagulation therapy over an average follow up period of 67.2 months.
Although no patient suffered an additional catastrophic APS event, 26% developed further thromboses despite administration of an anticoagulant, 40% of which occurred during a perioperative period.
Four APS-related deaths occurred during follow up. Two patients died due to perioperative complications, 1 due to pulmonary haemorrhage/infarcts, and 1 due to massive pulmonary embolism.
A small study population prevented meaningful comparison of disease management characteristics between institutions. Researchers recommended further study using large-scale registries.
Ann Rheum Dis 2003 Jun;62(6):530-3.
"Long term outcome of catastrophic antiphospholipid syndrome survivors"
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