HEMORRHAGIC COMPLICATIONS OF LONG-TERM ANTICOAGULANT-THERAPY IN 7 PATIENTS WITH SYSTEMIC LUPUS-ERYTHEMATOSUS AND ANTIPHOSPHOLIPID SYNDROME

Objective. To describe the presentation, course, and management of ser ious hemorrhagic complications of anticoagulant therapy for patients w ith antiphospholipid syndrome (APS). Methods. Charts of patients ident ified with serious bleeding complications from anticoagulation for APS were reviewed. Results. Patients included 6 women and one man with sy stemic lupus erythematosus (SLE) and one woman with primary APS. One p atient had 3 separate hemorrhagic events. There were 6 episodes of sub dural hematoma in 5 patients, one episode of pericarditis with tampona de, one episode of hemoptysis, and one episode of ovarian hemorrhage. In 2 patients, symptoms related to hemorrhage were initially attribute d to active SLE. Duration of anticoagulation was between one month and 10 years at the time of bleed. International normalized ratio (INR) a nd prothrombin time were above the intended range in 6/9 episodes. The re were no deaths and no permanent sequelae due to bleeding. Anticoagu lant therapy was resumed in 6/7 patients. Conclusion. The management o f APS must include vigilance, patient education, and anticoagulation t o maintain the WR between 3 and 3.5. To prevent hemorrhagic complicati ons, low molecular weight heparin is an option that deserves further s tudy.