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Analysis of Factors Influencing Recurrent Thrombosis

Sanja Krnic-Barrie, MD; Carolyn Riester O'Connor, MD; Stephen W. Looney, PhD; Silvia S. Pierangeli, PhD; E. Nigel Harris, MPhil, MD, DM

Arch Intern Med. 1997;157(18):2101-2108.

Abstract
Background
Antiphospholipid syndrome (APS) is a disorder of recurrent venous or arterial thrombosis, pregnancy losses, and thrombocytopenia. Recurrent thrombosis has particularly adverse effects on patient prognosis. The factors that influence recurrence and management techniques that prevent these events remain controversial. To add further insight regarding predisposing factors and the prevention of thrombotic recurrence, 61 wellcharacterized patients with APS were followed up for a median time of 77 months.

Methods
A retrospective cohort study was conducted in which the following factors were examined to determine their influence on thrombotic recurrence: primary vs secondary syndrome; the presence of hypertension, hyperlipidemia, diabetes, or smoking; patient age, sex, and race; pregnancy and oral contraceptives use; and treatment with warfarin sodium, warfarin plus aspirin, aspirin alone, prednisone, or no treatment.

Results
There was no difference between patients with primary and secondary APS with respect to recurrent arterial (55% vs 38%, respectively) or recurrent venous (47% vs 50%, respectively) thrombotic events. In all patients with APS, white race (P=.02) was associated with recurrent arterial events. Venous thrombosis occurred during pregnancy or in the postpartum period in 16 (30%) of 53 women and in 8 women taking oral contraceptives. Recurrent arterial and venous thromboses were significantly decreased with prophylactic warfarin use when compared with prednisone use or no treatment. Recurrences were infrequent in patients with prothrombin ratios of 1.5 to 2.0.

Conclusions
Treatment with warfarin was most effective in preventing recurrent arterial and venous thrombosis. Pregnancy and the use of oral contraceptives or prednisone may also influence recurrence.

Arch Intern Med. 1997;157:2101-2108

Author Affiliations
From the Division of Rheumatology, Department of Medicine (Dr Krnic-Barrie), and the Department of Family and Community Medicine (Dr Looney), University of Louisville, Louisville, Ky; the Department of Medicine, Cooper Hospital, and the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School at Camden, Camden, NJ (Dr O'Connor); and the Department of Microbiology/Immunology (Dr Pierangeli) and the Office of the Dean (Dr Harris), Morehouse School of Medicine, Atlanta, Ga.

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