Characteristics of patients with antiphospholipid syndrome with major bleeding after oral anticoagulant treatment

Objective-To study the demographic and clinical characteristics of patients with antiphospholipid syndrome (APS) with serious haemorrhagic complicatio ns of anticoagulant treatment in an attempt to establish risk factors for b leeding. Methods-Patients with APS who were attending our lupus unit and who present ed with severe bleeding while receiving oral anticoagulation were studied r etrospectively. Severe bleeding was defined by the need for admission to ho spital. Demographic data, clinical features, concomitant diseases and drugs , warfarin doses, duration of anticoagulation, and International Normalised Ratios (INR) at the time of bleeding were collected. Results-Fifteen patients were included in the study (12 with systemic lupus erythematosus (SLE) plus APS and 3 with primary APS). The median age was 4 1.7 (range 27-66) and the median duration of the disease was 12.9 years (ra nge 3-22). Duration of anticoagulation was between 10 days and 17 years. Th e INR at the time of bleeding was under 3 in 4 patients, between 3 and 4 in 5 patients and above 4 in 6 patients. There were 1 episodes of subdural ha ematoma, 4 episodes of renal haematoma (two after renal biopsy), 2 episodes of ovarian haemorrhage, 2 episodes of rectal haemorrhage, 1 episode of men orrhagia, 1 episode of haemarthrosis, and 1 episode of spinal haematoma. Co ncomitant drugs were aspirin in 9 patients, antibiotics in 2 patients, and azathioprine in 3 patients. In 6 patients hypertension was present as a con comitant disease. There were no deaths due to bleeding. Anticoagulant treat ment was restarted in all patients and 3 of them had a new episode of bleed ing. Conclusion-No relation was established between age, duration of oral antico agulant treatment, and bleeding. Concomitant drugs, mainly aspirin, and hig h blood pressure were present at the time of bleeding in a large number of patients.