Anticoagulation withdrawal in antiphospholipid syndrome: a retrospective matched-control study. (March 2018)

• Record Type: Journal Article
• Authors: Yelnik, C M; Urbanski, G; Drumez, E; Caron, C; Maillard, H; Morell-Dubois, S; Dubucquoi, S; Launay, D; Hachulla, E; Hatron, P Y; Duhamel, A; Lambert, M
• Is Part Of: Lupus. Volume 27:Number 3(2018)
• Page Start: 357
• Page End: 364
• Publication Date: 2018-03
• Subjects: Anticoagulant therapy -- antiphospholipid syndrome -- antiphospholipid antibody -- relapse -- thrombosis; Systemic lupus erythematosus -- Periodicals; 616.772005
• DOI: 10.1177/0961203317721751
• Languages: English
• ISSNs: 0961-2033

Abstract

Background/Purpose: Long-term anticoagulation is the standard treatment for thrombotic antiphospholipid syndrome (APS). However, in daily practice, the question of withdrawing anticoagulation may arise, without any evidence-based recommendations. This study aimed to assess outcomes in APS patients after anticoagulation withdrawal. Methods: Thrombotic APS patients followed in our centre, whose anticoagulation was withdrawn after APS diagnosis, were retrospectively selected, and were match-controlled with patients under anticoagulation, based on sex, age, APS clinical phenotype and disease duration. Results: Thirty cases with anticoagulation withdrawal were included. Median follow-up was 51 months (12–124). The risk of thrombotic relapse was higher in cases compared to controls (7.3% versus 1.5% patient-year ( p = 0.01 ); hazard ratio 4.8; 95% confidence interval (1.4–16.7)). Male gender, anti-β2GP1 and triple positivity at inclusion were predictive factors for thrombotic relapse. Conversely, aspirin prescription was a protective factor against relapses. Persistence of LA, anti-β2GP1 and triple positivity over time were associated with a higher risk of thrombosis and aPL disappearance with a lower risk. Conclusion: In our study, anticoagulation withdrawal was associated with an increased risk of thrombotic relapse. Our findings emphasize the influence of anti-β2GP1 and triple positivity persistence over time on the risk of relapse and the benefit of aspirin prescription when anticoagulation has been withdrawn.