Ginsberg J S, Wells P S, Brill-Edwards P, Donovan D, Moffatt K, Johnston M, Stevens P, Hirsh J
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Blood. 1995 Nov 15;86(10):3685-91.
The clinical relevance of antiphospholipid antibodies (APLA) in patients without systemic lupus erythematosus who have venous thromboembolism (VTE) in unknown. Limited evidence suggests that there is an association between the presence of APLA and both initial and recurrent episodes of VTE and that patients with APLA and VTE are resistant to warfarin therapy. Unselected patients with a first episode of clinically suspected deep vein thrombosis or pulmonary embolism were evaluated with objective tests for VTE and with laboratory tests for APLA; the latter included tests for the lupus anticoagulant (LA) and anticardiolipin antibodies (ACLA). Patients with VTE were treated with anticoagulant therapy and observed during and after discontinuation of anticoagulants for symptomatic recurrence of VTE. There was a strong association between LA and VTE (odds ratio, 9.4; 95% confidence interval [CI], 2.1 to 46.2) and 9 to 65 (14%; 95% CI, 7% to 25%) patients with VTE had LA. There was no association between the presence of ACLA and VTE (odds ratio, 0.7; 95%CI, 0.3 to 1.7) because of the high frequency of positive ACLA assays in patients without VTE. None of the 16 patients with VTE and APLA developed recurrent VTE while receiving warfarin therapy. There was no difference in rates of recurrent VTE in patients with or without APLA after anticoagulant therapy was discontinued. The strong association between LA and VTE suggests that testing for LA in patients with VTE is useful. The measurement of ACLA in patients with VTE has no clinical usefulness because the results are abnormal in a high proportion of patients without VTE. Although the presence of APLA in patients with VTE was not associated with resistance to a conventional intensity of warfarin or an increased risk of recurrent VTE after discontinuation of warfarin, a larger study should address these issues in a subgroup of patients with VTE and LA.
抗磷脂抗体（APLA）在无系统性红斑狼疮但发生静脉血栓栓塞（VTE）患者中的临床相关性尚不清楚。有限的证据表明，APLA的存在与VTE的首发及复发事件之间存在关联，且APLA合并VTE的患者对华法林治疗耐药。对未经选择的首次发生临床疑似深静脉血栓形成或肺栓塞的患者进行了VTE的客观检查及APLA的实验室检查；后者包括狼疮抗凝物（LA）及抗心磷脂抗体（ACLA）检测。VTE患者接受抗凝治疗，并在抗凝剂停用期间及之后观察VTE症状性复发情况。LA与VTE之间存在强关联（优势比，9.4；95%置信区间[CI]，2.1至46.2），9至65例（14%；95%CI，7%至25%）VTE患者存在LA。ACLA的存在与VTE无关联（优势比，0.7；95%CI，0.3至1.7），因为在无VTE患者中ACLA检测阳性的频率较高。16例VTE合并APLA患者在接受华法林治疗期间均未发生VTE复发。抗凝治疗停药后，有或无APLA患者的VTE复发率无差异。LA与VTE之间的强关联表明，对VTE患者进行LA检测是有用的。对VTE患者进行ACLA检测无临床意义，因为在很大一部分无VTE患者中结果均异常。虽然VTE患者中APLA的存在与对华法林常规剂量的耐药性或华法林停药后VTE复发风险增加无关，但一项更大规模的研究应在VTE合并LA的患者亚组中探讨这些问题。
