Khamashta M A, Cuadrado M J, Mujic F, Taub N A, Hunt B J, Hughes G R
Lupus and Arthritis Research Unit, Rayne Institute, St. Thomas' Hospital, London, United Kingdom.
N Engl J Med. 1995 Apr 13;332(15):993-7. doi: 10.1056/NEJM199504133321504.
The antiphospholipid-antibody syndrome is a thrombophilic disorder in which venous or arterial thrombosis, or both, may occur in patients with antiphospholipid antibodies. The optimal treatment of these patients is unclear. We assessed the efficacy of warfarin, low-dose aspirin, or both in the secondary prevention of thrombosis in patients with the syndrome.
One hundred forty-seven patients (124 [84 percent] of whom were female) with the antiphospholipid-antibody syndrome and a history of thrombosis were studied retrospectively. The syndrome was primary in 62 patients and was associated with systemic lupus erythematosus in 66 patients and lupus-like disease in 19. Each patient's history was reviewed.
One hundred one patients (69 percent) had a total of 186 recurrences of thrombosis. The median time between the initial thrombosis and the first recurrence was 12 months (range, 0.5 to 144 months). Treatment with high-intensity warfarin (producing an international normalized ratio of > or = 3) with or without low-dose aspirin (75 mg per day) was significantly more effective (P < 0.001 by the log-rank test) than treatment with low-intensity warfarin (producing an international normalized ratio of < 3) with or without low-dose aspirin or treatment with aspirin alone in preventing further thrombotic events (recurrence rates per patient-year, 0.013, 0.23, and 0.18, respectively). The rate of recurrence of thrombosis was highest (1.30 per patient-year) during the first six months after the cessation of warfarin therapy. Complications involving bleeding occurred in 29 patients during warfarin therapy and were severe in 7 (0.071 and 0.017 occurrence per patient-year, respectively).
The risk of recurrent thrombosis in patients with the antiphospholipid-antibody syndrome is high. Long-term anticoagulation therapy in which the international normalized ratio is maintained at or above 3 is advisable in these patients.
抗磷脂抗体综合征是一种易栓症，抗磷脂抗体阳性的患者可能发生静脉或动脉血栓形成，或两者皆有。这些患者的最佳治疗方法尚不清楚。我们评估了华法林、小剂量阿司匹林或两者联合应用在该综合征患者血栓形成二级预防中的疗效。
对147例有血栓形成病史的抗磷脂抗体综合征患者（其中124例[84%]为女性）进行回顾性研究。该综合征在62例患者中为原发性，在66例患者中与系统性红斑狼疮相关，在19例患者中与狼疮样疾病相关。对每位患者的病史进行了回顾。
101例患者（69%）共发生186次血栓复发。首次血栓形成与首次复发之间的中位时间为12个月（范围为0.5至144个月）。在预防进一步血栓事件方面，使用高强度华法林（国际标准化比值≥3）联合或不联合小剂量阿司匹林（每日75毫克）治疗比使用低强度华法林（国际标准化比值<3）联合或不联合小剂量阿司匹林或单独使用阿司匹林治疗显著更有效（对数秩检验P<0.001）（每位患者每年的复发率分别为0.013、0.23和0.18）。华法林治疗停止后的前六个月内血栓形成复发率最高（每位患者每年1.30次）。在华法林治疗期间，29例患者发生了出血并发症，其中7例严重（每位患者每年的发生率分别为0.071和0.017）。
抗磷脂抗体综合征患者血栓复发风险高。这些患者建议进行长期抗凝治疗，使国际标准化比值维持在3或以上。
Zotero 插件