ANTICARDIOLIPIN ANTIBODIES PREDICT EARLY RECURRENCE OF THROMBOEMBOLISM AND DEATH AMONG PATIENTS WITH VENOUS THROMBOEMBOLISM FOLLOWING ANTICOAGULANT-THERAPY

PURPOSE: To compare the risk of recurrent venous thromboembolism in pa tients with and without antiphospholipid antibodies. PATIENTS AND METH ODS: Anticardiolipin antibodies were tested 6 months after a first or second episode of venous thromboembolism. Of the patients with a first episode of venous thromboembolism only the 412 who received 6 months of anticoagulation were studied. Two hundred and eleven patients with a second episode received oral anticoagulation for 6 months or indefin itely. The therapy was targeted at an international normalized ratio ( INR) of 2.0 to 2.85. FLU patients were followed up for 4 years after e nrollment. RESULTS: Among the 412 patients with a first episode of ven ous thromboembolism the risk of recurrence was 29% in patients with an ticardiolipin antibodies and 14%, in those without antibodies (P = 0.0 013). In those with antibodies, there was an increased risk during the first 6 months after cessation of anticoagulation. The risk of recurr ence increased with the titer of the antibodies. Four-year mortality r ate was 15% in those with antibodies and 6% in those without (P = 0.01 ). Among 34 patients with a second event of venous thromboembolism and anticardiolipin antibodies, there were no recurrences during anticoag ulant therapy versus 20% in those who received only 6 months of treatm ent (P = 0.08). CONCLUSIONS: The presence of elevated titers of antica rdiolipin antibodies 6 months after an episode of venous thromboemboli sm is a predictor for an increased risk of recurrence and of death. Pa tients with anticardiolipin antibodies and venous thromboembolism seem to benefit from prolonged oral anticoagulation. (C) 1998 by Excerpta Medica, Inc.