Anticardiolipin Antibodies Predict Early Recurrence of Thromboembolism and Death Among Patients with Venous Thromboembolism Following Anticoagulant Therapy
Abstract
Purpose To compare the risk of recurrent venous thromboembolism in patients with and without antiphospholipid antibodies.Patients and methods 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 indefinitely. The therapy was targeted at an international normalized ratio (INR) of 2.0 to 2.85. All patients were followed up for 4 years after enrollment.Results Among the 412 patients with a first episode of venous thromboembolism the risk of recurrence was 29% in patients with anticardiolipin antibodies and 14% in those without antibodies (P = 0.0013). In those with antibodies, there was an increased risk during the first 6 months after cessation of anticoagulation. The risk of recurrence increased with the titer of the antibodies. Four-year mortality rate 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 anticoagulant therapy versus 20% in those who received only 6 months of treatment (P = 0.08).Conclusions The presence of elevated titers of anticardiolipin antibodies 6 months after an episode of venous thromboembolism is a predictor for an increased risk of recurrence and of death. Patients with anticardiolipin antibodies and venous thromboembolism seem to benefit from prolonged oral anticoagulation.
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Long-term anticoagulation in antiphospholipid syndrome is supported by two small direct comparison studies showing a lower risk of recurrent venous thrombosis among antiphospholipid syndrome patients on long-term versus 3-6 months of oral anticoagulation.
“Use of long-term anticoagulation in patients with APS is supported by two small direct comparison studies (one RCT, one retrospective cohort)28 29 that showed a lower risk of recurrent venous thrombosis among patients with APS on long-term vs 3–6 months of oral anticoagulation.”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [28]
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- Authors
- Schulman, S., Svenungsson, E., & Granqvist, S.
- Affiliations
- Karolinska University Hospital (SE)
- Ersta sjukhus (SE)
- Corresponding author
- Schulman, Sam
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 1998-04
- Volume
- 104
- Issue
- 4
- Pages
- 332-338
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2152900444
- Cited by
- 497
- References
- 24
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 9 · 2023: 6 · 2022: 4 · 2021: 5 · 2020: 10 · 2019: 13 · 2018: 9 · 2017: 10 · 2016: 13 · 2015: 8 · 2014: 9 · 2013: 18 · 2012: 21
- FWCI
- 19.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Hjärt-Lungfonden
- Karolinska Institutet
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- anticardiolipin antibodies, antiphospholipid antibodies, venous thromboembolism, thromboembolism recurrence, oral anticoagulation, long-term anticoagulation, mortality, antibody titers, international normalized ratio
- MeSH terms
- Aged, Anticoagulants, Cause of Death, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Recurrence, Risk, Thromboembolism, Antibodies, Anticardiolipin
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