Anjay Anand, MD
Anand A.; Anticardiolipin Antibodies and Hypercoagulability. Ann Intern Med. 1993;118:986-987. doi: 10.7326/0003-4819-118-12-199306150-00019
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Published: Ann Intern Med. 1993;118(12):986-987.
TO THE EDITOR:
Ginsburg and colleagues  are to be commended on their long-term study showing the enhanced risk posed by anticardiolipin antibodies for deep venous thrombosis and pulmonary embolism in healthy adult men. Although their mechanism of action is unknown, the anticardiolipin antibodies lead to a hypercoagulable state not only in systemic lupus erythematosus but also in the absence of disease.
The investigators found that low-dose aspirin was not protective and that thrombosis recurred despite therapeutic anticoagulation. A recent study  evaluating thrombosis in patients with antiphospholipid antibodies found that recurrence rates during no treatment; aspirin; and low-, intermediate-, and high-intensity warfarin therapy (international normalized ratios [INRs] < 1.9; 2.0 to 2.9; and > 3.0, respectively) were 0.19, 0.32, 0.57, 0.07 (P = 0.12), and 0.00 (P < 0.001) per patient-year, respectively. Although this study found no benefit with aspirin, it did find significant to complete protection when intermediate- to high-intensity warfarin was used as a prophylactic agent . When a decision to treat is made (for example, when high-titer anticardiolipin antibodies are associated with episodes of thrombosis), an INR of 3.0 should be set and reduced if a bleeding risk is perceived. Indefinite anticoagulation may prove useful in reliable patients with recurrent thrombotic episodes.
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