Tan B E, Thong B Y H, Shivananda S, Han W W, Chng H H
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital.
Lupus. 2009 Jul;18(8):752-8. doi: 10.1177/0961203309103303.
To examine the clinical manifestations, intensity of oral anticoagulation and outcomes in the prevention of recurrent thromboses in patients with antiphospholipid syndrome (APS) in a tertiary rheumatology centre in Singapore. Retrospective case review of consecutive patients with APS attending a rheumatology clinic from 1st January 2004 to 31st December 2005. There were 59 (44%) patients with definite APS and 75 (56%) with probable APS. Systemic lupus erythematosus (SLE) was the most common cause of secondary APS. Hypertension and hyperlipidaemia were the most common cardiovascular comorbidities. The most common manifestations were haematological (thrombocytopaenia and haemolytic anaemia), neurological (seizure, headache) and pulmonary hypertension. Among those with definite APS, there were similar proportions with arterial and venous thromboses. Recurrent thromboses occurred in 14 (23.7%) patient with definite APS receiving warfarin, comprising 14 (73.7%) episodes of arterial and 5 (26.3%) episodes of venous thromboses. Recurrent arterial thromboses occurred at international normalized ratio (INR) of <2 in 5 (35.7%), INR 2-3 in 6 (42.9%), INR > 3 in 3 (21.4%) episodes, respectively. Recurrent venous thromboses occurred at INR < 2 in 4 (80.0%) and INR > 3 in 1 (20.0%) episode, respectively. Twenty-eight episodes of bleeding occurred in 21 (35.6%) patients, the majority (78.6%) being minor bleeding. Two-thirds of all major bleeds occurred at INR >/= 3. Venous and arterial thromboses were equally common in our patients with definite APS, although recurrent thromboses were more common in the arterial circulation. Target INR > 3 was associated with lower rates of recurrent arterial thromboses but higher rates of major and recurrent bleeding. Target INR >/= 2 appeared to be sufficient to prevent recurrent venous thromboses.
在新加坡一家三级风湿病中心，研究抗磷脂综合征（APS）患者预防复发性血栓形成的临床表现、口服抗凝强度及结局。对2004年1月1日至2005年12月31日在风湿病门诊就诊的连续性APS患者进行回顾性病例分析。有59例（44%）确诊APS患者和75例（56%）可能APS患者。系统性红斑狼疮（SLE）是继发性APS最常见的病因。高血压和高脂血症是最常见的心血管合并症。最常见的表现为血液系统（血小板减少和溶血性贫血）、神经系统（癫痫、头痛）和肺动脉高压。在确诊APS患者中，动脉和静脉血栓形成的比例相似。接受华法林治疗的14例（23.7%）确诊APS患者发生复发性血栓形成，其中动脉血栓形成14例（73.7%），静脉血栓形成5例（26.3%）。复发性动脉血栓形成时，国际标准化比值（INR）<2的有5例（35.7%），INR 2 - 3的有6例（42.9%），INR>3的有3例（21.4%）；复发性静脉血栓形成时，INR<2的有4例（80.0%），INR>3的有1例（20.0%）。21例（35.6%）患者发生28次出血事件，大多数（78.6%）为轻微出血。所有严重出血事件的三分之二发生在INR≥3时。在我们确诊APS的患者中，静脉和动脉血栓形成同样常见，尽管复发性血栓形成在动脉循环中更常见。目标INR>3与较低的复发性动脉血栓形成率相关，但严重和复发性出血率较高。目标INR≥2似乎足以预防复发性静脉血栓形成。
