The Effects of Low-intensity Warfarin on Coagulation Activation in Patients with Antiphospholipid Antibodies and Systemic Lupus Erythematosus

James D. Douketis; Mark A. Crowther; James A. Julian; Katheryne Stewart; Dianne Donovan; Elzbieta A. Kaminska; Carl A. Laskin; Jeffrey S. Ginsberg

doi:10.1055/s-0037-1614324

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1999; 82(03): 1028-1032
DOI: 10.1055/s-0037-1614324

Letters to the Editor

Schattauer GmbH

The Effects of Low-intensity Warfarin on Coagulation Activation in Patients with Antiphospholipid Antibodies and Systemic Lupus Erythematosus

James D. Douketis

¹From the Departments of Medicine, Toronto, Canada

,

Mark A. Crowther

¹From the Departments of Medicine, Toronto, Canada

,

James A. Julian

²Clinical Epidemiology and Biostatistics, McMaster University, Hamilton Canada, Canada

,

Katheryne Stewart

¹From the Departments of Medicine, Toronto, Canada

,

Dianne Donovan

¹From the Departments of Medicine, Toronto, Canada

,

Elzbieta A. Kaminska

¹From the Departments of Medicine, Toronto, Canada

,

Carl A. Laskin

³Department of Medicine, The Toronto Hospital, University of Toronto, Toronto, Canada

,

Jeffrey S. Ginsberg

¹From the Departments of Medicine, Toronto, Canada

› Author Affiliations

Abstract

Summary

The optimal intensity of oral anticoagulant therapy for the prevention of thromboembolism in patients with antiphospholipid antibodies (APLA) and systemic lupus erythematosus is controversial. Retrospective studies have suggested that patients with APLA are resistant to oral anticoagulant therapy, with a targeted International Normalization Ratio (INR) of 2.0 to 3.0, and that a higher intensity of anticoagulation (INR: 2.6 to 4.5) is required to prevent recurrent thromboembolism. To investigate if patients with APLA are resistant to the anticoagulant effect of low intensities of warfarin therapy, we performed a randomized trial in which 21 patients with APLA and systemic lupus erythematosus were allocated to receive one of three intensities of warfarin (INR: 1.1 to 1.4, 1.5 to 1.9 or 2.0 to 2.5) or placebo for four months. The main outcome was the effect of each intensity of warfarin therapy on prothrombin fragment 1+2 level (F1+2), that was used as a marker of coagulation activation. When F1+2 levels in patients allocated to the three warfarin intensities were compared to F1+2 levels in the placebo group, there was a statistically significant decrease (p <0.05) in the patient group receiving warfarin with a targeted INR of 2.0 to 2.5 at two, three and four months, and in the patient group with a targeted of INR 1.5 to 1.9 at three months. We conclude that in patients with APLA and systemic lupus erythematosus, warfarin therapy, with a targeted INR of 2.0 to 2.5, is effective in suppressing coagulation activation, and therefore, might be effective in preventing thromboembolism.

Keywords

Thromboembolism - antiphospholipid antibodies - anticoagulation

Full Text

References

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