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Recurrence of thrombosis in patients with primary antiphospholipid syndrome: emphasis on arterial events

Antonio R Cabral1, Alonso Turrent-Carriles2, Irazu Contreras-Yáñez3

  • 1Division of Rheumatology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Canada.

Clinical and Experimental Rheumatology
|July 22, 2025
PubMed

Insights

Previous thrombotic events and anticoagulation intensity are key risk factors for rethrombosis in antiphospholipid syndrome (APS). Maintaining an international normalized ratio (INR) between 2.5-3.5 significantly protects against recurrent thrombosis, including arterial events.

Area of Science:

  • Rheumatology
  • Hematology
  • Clinical Medicine

Background:

  • Antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis.
  • Effective anticoagulation management is crucial for preventing recurrent thrombotic events in APS patients.
  • Understanding specific risk factors for rethrombosis is essential for optimizing treatment strategies.

Purpose of the Study:

  • To identify risk factors associated with rethrombosis in patients with primary antiphospholipid syndrome (APS).
  • To evaluate the impact of anticoagulation intensity, measured by the international normalized ratio (INR), on rethrombosis risk.
  • To determine optimal INR ranges for preventing recurrent thrombotic events in APS.

Main Methods:

  • Retrospective analysis of 81 patients with thrombotic APS treated with vitamin K antagonists (VKAs).
  • Inclusion of patients with at least one year of follow-up and a minimum of four INR determinations annually.
  • Statistical analysis using Cox survival models and hazard function curves to assess rethrombosis risk factors and anticoagulation intensity.

Main Results:

  • The study identified a history of previous rethrombosis and inadequate anticoagulation intensity (INR < 2.5) as significant risk factors for recurrent thrombosis.
  • Patients maintaining an INR between 2.5 and 3.5 demonstrated a lower cumulative risk of rethrombosis compared to those with INR < 2.5.
  • A mean INR of 2.2 was associated with an increased risk of rethrombosis, highlighting the importance of achieving target INR levels.

Conclusions:

  • The number of prior thrombotic events and the intensity of anticoagulation are critical determinants of rethrombosis risk in APS.
  • An international normalized ratio (INR) maintained within the 2.5-3.5 range provides protection against re-thrombosis, including arterial events.
  • These findings underscore the importance of rigorous anticoagulation monitoring and achieving target INR levels for APS patients to prevent recurrent thrombosis.
Abstract

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