Comarmond C, Jego P, Veyssier-Belot C, Marie I, Mekinian A, Elmaleh-Sachs A, Leroux G, Saadoun D, Oziol E, Fraisse T, Hyvernat H, Thiercein-Legrand M-F, Sarrot-Reynauld F, Ferreira-Maldent N, de Menthon M, Goujard C, Khau D, Nguen Y, Monnier S, Michon A, Castel B, Decaux O, Piette J-C, Cacoub P
1 Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
2 Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France.
Lupus. 2017 Oct;26(12):1291-1296. doi: 10.1177/0961203317699285. Epub 2017 Mar 29.
Objective To study the outcome of patients with antiphospholipid syndrome (APS) after oral anticoagulant treatment cessation. Methods We performed a retrospective study of patients with APS experiencing cessation of oral anticoagulant and enrolled in a French multicentre observational cohort between January 2014 and January 2016. The main outcome was the occurrence of recurrent thrombotic event after oral anticoagulation cessation. Results Forty four APS patients interrupted oral anticoagulation. The median age was 43 (27-56) years. The median duration of anticoagulation was 21 (9-118) months. Main causes of oral anticoagulant treatment cessation were switch from vitamin K antagonists to aspirin in 15 patients, prolonged disappearance of antiphospholipid antibodies in ten, bleeding complications in nine and a poor therapeutic adherence in six. Eleven (25%) patients developed a recurrent thrombotic event after oral anticoagulation cessation, including three catastrophic APS and one death due to lower limb ischemia. Antihypertensive treatment required at time of oral anticoagulants cessation seems to be an important factor associated with recurrent thrombosis after oral anticoagulant cessation (15.2% in patients with no relapse versus 45.5% in patients with recurrent thrombosis, p = 0.038). Oral anticoagulant treatment was re-started in 18 (40.9%) patients. Conclusion The risk of a new thrombotic event in APS patients who stopped their anticoagulation is high, even in those who showed a long lasting disappearance of antiphospholipid antibodies. Except for the presence of treated hypertension, this study did not find a particular clinical or biological phenotype for APS patients who relapsed after anticoagulation cessation. Any stopping of anticoagulant in such patients should be done with caution.
目的 研究抗磷脂综合征（APS）患者停用口服抗凝治疗后的结局。方法 我们对2014年1月至2016年1月期间在法国一个多中心观察性队列中停用口服抗凝剂的APS患者进行了一项回顾性研究。主要结局是口服抗凝剂停用后复发性血栓事件的发生。结果 44例APS患者中断了口服抗凝治疗。中位年龄为43（27 - 56）岁。抗凝的中位持续时间为21（9 - 118）个月。口服抗凝治疗停用的主要原因包括：15例患者从维生素K拮抗剂转换为阿司匹林，10例患者抗磷脂抗体长期消失，9例患者出现出血并发症，6例患者治疗依从性差。11例（25%）患者在口服抗凝剂停用后发生了复发性血栓事件，包括3例灾难性APS和1例因下肢缺血死亡。口服抗凝剂停用时需要进行的降压治疗似乎是与口服抗凝剂停用后复发性血栓形成相关的一个重要因素（无复发患者为15.2%，复发性血栓形成患者为45.5%，p = 0.038）。18例（40.9%）患者重新开始了口服抗凝治疗。结论 停用抗凝治疗的APS患者发生新的血栓事件的风险很高，即使是那些抗磷脂抗体长期消失的患者。除了存在已治疗的高血压外，本研究未发现抗凝剂停用后复发的APS患者有特定的临床或生物学表型。对此类患者的任何抗凝剂停用都应谨慎进行。
