Antiphospholipid antibody associated thrombosis: a consensus for treatment?

The results of several studies have demonstrated that antiphospholipid antibodies (APLA) are associated with an increased risk of both venous and arterial thrombosis. Additional work has suggested that patients with antiphospholipid antibody-associated thrombosis are at a markedly increased risk for recurrent thrombotic disease, and several investigators have suggested that such patients should receive high-intensity anticoagulant therapy for an indefinite period of time for prophylaxis of recurrent thrombotic events. However, the majority of these studies are retrospective and include highly-selected patient populations, and the potential morbidity of long-term, intensive warfarin therapy has not been fully considered. In this article, studies concerning the incidence and prevention of recurrent thrombosis in patients with antiphospholipid antibodies are reviewed. I will also present the results of a survey in which opinions concerning selected issues in prophylactic anticoagulant therapy of patients with antiphospholipid antibody-associated venous thrombosis were obtained from prominent clinicians with expertise in this area. The results of the survey demonstrate that opinions concerning this issue vary widely, and emphasize the need for additional prospective studies examining the utility of specific anticoagulant regimens in the prophylaxis of recurrent thromboembolism in patients with antiphospholipid antibodies.