Silva Felipe Freire da, Carvalho Jozélio Freire de
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Centro Médico do Hospital Aliança, Salvador, BA, Brasil.
Rev Bras Reumatol. 2015 Mar-Apr;55(2):159-66. doi: 10.1016/j.rbr.2014.08.016. Epub 2014 Nov 1.
Discussion about the intensity of warfarin in patients with antiphospholipid syndrome (APS) remains present in our days.
To evaluate which intensity of anticoagulation with warfarin is associated with a greater reduction of thromboembolic events in the treatment of patients with APS, as well as assess the risk of bleeding in the different treatment modalities.
A systematic review of the literature was carried out with search from electronic databases: PubMed, LILACS and SciELO, with the use of the key-words: treatment, warfarin, antiphospholipid syndrome, antiphospholipid antibody syndrome and their respective translations into Portuguese, in different combinations. In addition, a meta-analysis with the aid of Review Manager 5.2 software by Cochrane was performed.
Only two articles met the inclusion criteria for this study. Regarding the main outcome assessed in this study, the two studies showed similar values, indicating higher frequency of thrombotic events in high-intensity groups. The comparative analysis of the randomized clinical trial evaluated showed an increased thrombotic risk for those patients who received intervention with high-intensity warfarin. Another finding of the meta-analysis was the higher incidence of minor bleeding, also in the experimental group, that received warfarin keeping International Normalized Ratio (INR) > 3.
In individuals with APS and prevalence of venous events, the use of moderate intensity (MI) anticoagulation (INR: 2-3) is the most suitable. However, this evidence cannot yet be extended to patients with arterial events, due to the limited representation of this sample of subjects in the two clinical trials included in this meta-analysis.
如今，关于抗磷脂综合征（APS）患者华法林治疗强度的讨论依然存在。
评估华法林不同抗凝强度在治疗APS患者时，与血栓栓塞事件减少幅度更大之间的关联，同时评估不同治疗方式下的出血风险。
通过电子数据库进行文献系统综述，检索数据库包括：PubMed、LILACS和SciELO，使用关键词：治疗、华法林、抗磷脂综合征、抗磷脂抗体综合征及其各自的葡萄牙语翻译，以不同组合进行检索。此外，借助Cochrane的Review Manager 5.2软件进行荟萃分析。
仅有两篇文章符合本研究的纳入标准。关于本研究评估的主要结果，两项研究显示出相似的值，表明高强度组血栓形成事件的发生率更高。对所评估的随机临床试验进行的对比分析表明，接受高强度华法林干预的患者血栓形成风险增加。荟萃分析的另一项发现是，接受使国际标准化比值（INR）>3的华法林治疗的实验组，轻微出血的发生率也更高。
在患有APS且有静脉事件的个体中，使用中等强度（MI）抗凝（INR：2 - 3）最为合适。然而，由于本荟萃分析纳入的两项临床试验中该样本受试者的代表性有限，这一证据尚不能推广至患有动脉事件的患者。
