Long-Term Functional Prognosis Poor in Primary Antiphospholipid Syndrome

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Long-Term Functional Prognosis Poor in Primary Antiphospholipid Syndrome

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WESTPORT, CT (Reuters Health) Jan 11 - Thrombotic events remain a risk in

patients being treated with aspirin or warfarin for antiphospholipid syndrome

(APS), according to a retrospective analysis of patient records at the Weill

Medical College of Cornell University, in New York.

The investigators note that their study involved the largest group of patients

with primary antiphospholipid syndrome to be followed for more than a decade.

Dr. Doruk Erkan and associates identified 39 APS patients who developed a first

thrombotic event or pregnancy before 1990. Excluded were patients with systemic

lupus erythematosus or other connective tissue disorders.

During the 10 to 22 years of follow-up after the initial clinical event, " one

third of patients had organ damage and one fifth were unable to perform everyday

activities, " the researchers write in the December 2000 issue of the Journal of

Rheumatology.

Damage included hemiparesis in eight patients and dementia independent of stroke

in three. Single cases of dilated cardiomyopathy-myocardial infarction, massive

pulmonary infarction, quadriplegia, and end-stage renal disease were also

observed. Nine patients developed cardiac valve lesions; 13% underwent cardiac

valve replacement during follow-up.

" We believe multiple factors might account for this poor outcome, " Dr. Erkan

told Reuters Health. " Most importantly, antiphospholipid syndrome is a

relatively newly recognized syndrome; thus, delay in the diagnosis and treatment

in the early years may have contributed to the recurrent thrombotic events. "

Treatment with warfarin in 21 patients reduced the recurrence rate to 19% from

the 62% observed before therapy was initiated. Twelve patients who had pregnancy

events as the only APS-related events, and were treated with aspirin, exhibited

no further major vascular thrombotic events.

" For antiphospholipid syndrome patients with vascular thrombotic events,

currently warfarin is the treatment of choice to prevent recurrence. However, 6

of 15 patients in our study - who were previously healthy - had organ damage

after the initial thrombotic event and this brings us to the issue of primary

prevention of thrombotic events, " Dr. Erkan explained.

" One subgroup of patients doesn't have the diagnosis of antiphospholipid

syndrome, meaning no vascular thrombotic events or pregnancy complications, but

they have autoantibodies in their blood and have high risk of thrombosis, " he

continued. " The management of these patients is very controversial and as

evidence-based support for long-term thrombosis prophylaxis is lacking, it is

not universally recommended. "

Dr. Erkan believes that " timely diagnosis and treatment of this syndrome is

crucial to improve the long-term outcomes. "

J Rheumatol 2000;27:2817-2821.

http://rheumatology.medscape.com/reuters/prof/2001/01/01.12/20010111clin003.html