Duncan P. Thomas, MD; Harold R. Roberts, MD
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Thomas DP, Roberts HR. Reply: Hypercoagulable States. Ann Intern Med. 1997;127:1128-1129. doi: 10.7326/0003-4819-127-12-199712150-00017
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Published: Ann Intern Med. 1997;127(12):1128-1129.
We thank Wilson and Gharavi for drawing attention to the problem of hypercoagulability and thrombosis in patients with the antiphospholipid syndrome. Although we agree that the mechanism of action of antiphospholipid antibodies is not fully understood and that prospective clinical trials are needed to establish definitive recommendations for treatment, we know of no evidence suggesting that the measurement of specific endogenous anticoagulant pathways, such as activated protein C or antithrombin III, provides information useful in the diagnosis or management of patients with the antiphospholipid syndrome. We would like, however, to modify our statement in relation to arterial thrombosis and resistance to activated protein C in light of a recent report showing that young women with factor V Leiden mutation have a fourfold increased risk for myocardial infarction . These recent data suggest that factor V Leiden mutation is a risk factor for arterial disease in young women (particularly if they smoke) but not in older men.
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