风湿

即使aPL转阴,APS患者停用口服抗凝治疗仍需慎重

作者:Comarmond C et al. 翻译:北医三院风湿免疫科刘畅 来源:中国风湿病公众论坛 日期:2018-06-14
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         即使aPL转阴,APS患者停用口服抗凝治疗仍需慎重

关键字:  APS 

        摘要:目的:研究APS患者停用口服抗凝治疗后的预后。

        方法:我们对在2014年1月至2016年1月期间在法国多中心观察队列中的的患者,进行了APS患者停用口服抗凝药的回顾性研究。主要结果是观察停用口服抗凝药物后再发血栓事件。

        结果:纳入44例停用口服抗凝药的患者。中位年龄为43岁(27-56岁)。中位抗凝药使用时间为21个月(9-118)。停用口服抗凝药的主要原因有:将Vit K拮抗剂更换为阿司匹林(15例),抗磷脂抗体长期阴性(10例),出血并发症(9例),治疗依从性差(6例)。11例在停用口服抗凝治疗后再发血栓,其中3例出现灾难性APS以及1例因下肢缺血性病变死亡。在口服抗凝治疗停止时需要降压治疗似乎是再发栓形成的一个重要因素(未复发患者15.2% Vs复发患者45.5%, p = 0.038)。18例再次启动抗凝治疗(40.9%) 。

        结论:APS患者停用抗凝治疗后再发血栓风险高,即使在长期抗磷脂抗体转阴的患者中,除了停药后的降压治疗,这个研究没有发现其他临床及生物学因素影响APS患者停用抗凝药物后再发血栓的风险。在APS患者中因任何原因停用抗凝药物均需谨慎。

        附原文:Abstract Objective To study the outcome of patients with antiphospholipid syndrome (APS) after oral anticoagulant treatment cessation. Methods We performed a retrospective study ofpatients with APS experiencing cessation of oral anticoagulant and enrolled in a French multicentre observational cohort between January 2014 and January 2016. The main outcome was the occurrence of recurrent thrombotic event after oralanticoagulation cessation. Results Forty four APS patients interrupted oral anticoagulation. The median age was 43 (27-56) years. The median duration of anticoagulation was 21 (9-118) months. Main causes of oral anticoagulant treatment cessation were switch from vitamin K antagonists to aspirin in 15 patients, prolonged disappearance of antiphospholipid antibodies in ten, bleeding complications in nine and a poor therapeutic adherence in six. Eleven (25%) patients developed a recurrent thrombotic event after oral anticoagulation cessation, including three catastrophicAPS and one death due to lower limb ischemia. Antihypertensive treatment required at time of oral anticoagulants cessation seems to be an important factor associated with recurrent thrombosis after oral anticoagulant cessation (15.2% in patients with no relapse versus 45.5% in patients with recurrent thrombosis, p = 0.038). Oral anticoagulant treatment was re-started in 18 (40.9%) patients. Conclusion The risk of a new thrombotic event in APS patients who stopped their anticoagulation is high, even in those who showed a long lasting disappearance of antiphospholipid antibodies. Except forthe presence of treated hypertension, this study did not find a particular clinical or biological phenotype for APS patients who relapsed after anticoagulation cessation. Any stopping of anticoagulant in such patients should be done with caution.

        引自:Comarmond C et al,Cessation of oral anticoagulants in antiphospholipid syndrome,Lupus. 2017 Oct;26(12):1291-1296.

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