Antiphospholipid antibodies and the risk of recurrence after a first episode of venous thromboembolism: a systematic review.

Laboratory evidence of antiphospholipid antibodies (APLA) in patients with a first episode of venous thromboembolism (VTE) is often considered an indication for indefinite anticoagulant therapy, but it is uncertain if this practice is justified. We performed a systematic review to determine whether the presence of APLA in patients with a first VTE is associated with an increased risk of recurrence. We searched PubMed, CINAHL, Cochrane, EMBASE, and Web of Knowledge through February 2012 and included prospective studies that met prespecified design criteria. There were 109 recurrent VTE in 588 patients with APLA and 374 recurrent VTE in 1914 patients without APLA (relative risk 1.41; 95% confidence interval [CI], 0.99 to 2.36). The unadjusted risk ratio for recurrent VTE after stopping anticoagulant therapy in patients with an anticardiolipin antibody was 1.53 (95% CI, 0.76-3.11), and with a lupus anticoagulant was 2.83 (95% CI, 0.83-9.64). All studies had important methodologic limitations and we judged the overall quality of the evidence as very low. Although a positive APLA test appears to predict an increased risk of recurrence in patients with a first VTE, the strength of this association is uncertain because the available evidence is of very low quality.

[1]  C. Bombardier,et al.  Assessing Bias in Studies of Prognostic Factors , 2013, Annals of Internal Medicine.

[2]  Paolo Prandoni,et al.  Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. , 2012, Chest.

[3]  Sabino Iliceto,et al.  Incidence of a first thromboembolic event in asymptomatic carriers of high-risk antiphospholipid antibody profile: a multicenter prospective study. , 2011, Blood.

[4]  M. Khamashta,et al.  Evidence-based recommendations for the prevention and long-term management of thrombosis in antiphospholipid antibody-positive patients: Report of a Task Force at the 13th International Congress on Antiphospholipid Antibodies , 2011, Lupus.

[5]  M. Monreal,et al.  Thrombophilia testing in patients with venous thromboembolism. Findings from the RIETE registry. , 2009, Thrombosis research.

[6]  W. Ageno,et al.  Duration of anticoagulant treatment and recurrence of venous thromboembolism in patients with and without thrombophilic abnormalities , 2009, Thrombosis and Haemostasis.

[7]  S. Kahn,et al.  Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy , 2008, Canadian Medical Association Journal.

[8]  M. Khamashta,et al.  How we diagnose and treat thrombotic manifestations of the antiphospholipid syndrome: a case-based review. , 2007, Blood.

[9]  S. Kahn,et al.  Association between antiphospholipid antibodies and recurrent fetal loss in women without autoimmune disease: a metaanalysis. , 2006, The Journal of rheumatology.

[10]  S. Schulman,et al.  Risk of recurrent venous thromboembolism or bleeding in relation to thrombophilic risk factors in patients receiving ximelagatran or placebo for long‐term secondary prevention of venous thromboembolism , 2006, British journal of haematology.

[11]  O. Linder,et al.  Post‐thrombotic syndrome, recurrence, and death 10 years after the first episode of venous thromboembolism treated with warfarin for 6 weeks or 6 months , 2006, Journal of thrombosis and haemostasis : JTH.

[12]  Y. Shoenfeld,et al.  International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS) , 2006, Journal of thrombosis and haemostasis : JTH.

[13]  R. Derksen,et al.  Pathophysiology of the antiphospholipid syndrome , 2005, Journal of thrombosis and haemostasis : JTH.

[14]  J. Douketis,et al.  Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor , 2004, Journal of thrombosis and haemostasis : JTH.

[15]  H. Büller,et al.  Acquired and Inherited Thrombophilic Factors and the Risk for Residual Venous Thrombosis , 2003, Pathophysiology of Haemostasis and Thrombosis.

[16]  W. Ageno,et al.  Extended Oral Anticoagulant Therapy after a First Episode of Pulmonary Embolism , 2003, Annals of Internal Medicine.

[17]  T. Barbui,et al.  Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. , 2003, Blood.

[18]  W. Ageno,et al.  Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators. , 2001, The New England journal of medicine.

[19]  W. Ageno,et al.  Warfarin Optimal Duration Italian Trial Investigators. Three months versus one year of oral anticoagulant therapy for idiopatic deep venous thrombosis. , 2001 .

[20]  M Gent,et al.  A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. , 1999, The New England journal of medicine.

[21]  M. Petri.  Thrombosis and systemic lupus erythematosus: the Hopkins Lupus Cohort perspective. , 1996, Scandinavian journal of rheumatology.

[22]  P. Brill-Edwards,et al.  Antiphospholipid antibodies and venous thromboembolism. , 1995, Blood.

[23]  J. Batlle,et al.  Prevalence, Follow-Up and Clinical Significance of the Anticardiolipin Antibodies in Normal Subjects , 1994, Thrombosis and Haemostasis.

[24]  P. D. de Groot,et al.  Patients with antiphospholipid antibodies and venous thrombosis should receive long term anticoagulant treatment. , 1993, Annals of the rheumatic diseases.

[25]  B. Chong,et al.  Prevalence of lupus anticoagulant and anticardiolipin antibodies in a healthy population. , 1990, Australian and New Zealand journal of medicine.