Brunner Hermine I, Chan Wee-Shian, Ginsberg Jeffrey S, Feldman Brian M
Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Ohio 45229, USA.
J Rheumatol. 2002 Mar;29(3):490-501.
Patients with antiphospholipid antibody syndrome (APS) have a high risk for rethrombosis. Anticoagulation with warfarin and aspirin reduces the frequency of recurrences. No universally accepted approach regarding the duration and intensity of antithrombotic therapy exists. We investigated the best antithrombotic regimen for patients with APS after the first deep venous thrombosis (DVT).
We identified 6 anticoagulation regimens used in such patients, the rates of morbidity and mortality associated with bleeding, and the rates of recurrent thrombosis associated with APS by literature search. A decision tree was developed and the expected risks and benefits of each anticoagulation regimen were assessed at 2 different time points: at one year and again 4 years after the initial thrombosis.
Based on the decision analysis, longterm warfarin alone at an international normalization ratio (INR) between 3.0 and 4.0 had the highest expected utility of the 6 antithrombotic regimens, both one year and 4 years after the initial venous thrombotic event. Short term anticoagulation for only 6 months is less beneficial. Combination therapy of warfarin and aspirin (ASA) does not offer an improvement in the expected utility over warfarin alone.
Although the applicability of this analysis to clinical decision-making is not entirely clear, patients with APS presenting with DVT appear to benefit from longterm warfarin (INR 3.0-4.0) that may be superior to warfarin (INR 2.0-3.0). Short term warfarin therapy seems to be less beneficial and the use of ASA does not offer a clear additional benefit. Randomized controlled trials are needed to provide a better basis for recommendations for the treatment APS.
抗磷脂抗体综合征（APS）患者再次发生血栓形成的风险很高。使用华法林和阿司匹林进行抗凝治疗可降低复发频率。目前尚无关于抗血栓治疗持续时间和强度的普遍接受的方法。我们研究了首次发生深静脉血栓形成（DVT）后APS患者的最佳抗血栓治疗方案。
通过文献检索，我们确定了此类患者使用的6种抗凝方案、与出血相关的发病率和死亡率以及与APS相关的复发性血栓形成率。绘制了决策树，并在两个不同时间点评估了每种抗凝方案的预期风险和益处：初始血栓形成后1年和4年。
基于决策分析，在初始静脉血栓形成事件后的1年和4年，单独使用长期华法林，国际标准化比值（INR）维持在3.0至4.0时，在6种抗血栓方案中预期效用最高。仅进行6个月的短期抗凝治疗益处较小。华法林与阿司匹林（ASA）联合治疗在预期效用方面并不优于单独使用华法林。
尽管该分析在临床决策中的适用性尚不完全明确，但出现DVT的APS患者似乎受益于长期华法林治疗（INR 3.0 - 4.0），这可能优于华法林治疗（INR 2.0 - 3.0）。短期华法林治疗似乎益处较小，且使用ASA并未带来明显的额外益处。需要进行随机对照试验，以便为APS治疗建议提供更好的依据。
