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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2009;29:321.)
© 2009 American Heart Association, Inc.

Venous Thromboembolism: Mechanisms, Treatment, and Public Awareness

Venous Thrombosis in the Antiphospholipid Syndrome

Mary Katherine Farmer-Boatwright; Robert A.S. Roubey

From the Division of Rheumatology, Allergy and Immunology, Department of Medicine, and Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill.

Correspondence to Dr Robert Roubey, Division of Rheumatology, Allergy and Immunology, CB #7280, Rm. 3330 Thurston Bldg, UNC-CH, Chapel Hill, NC 27599-7280. E-mail roubey{at}med.unc.edu

The antiphospholipid syndrome is a relatively common acquired cause of venous thrombosis. Up to 20% of cases of deep vein thrombosis, with and without pulmonary embolism, may be associated with antiphospholipid antibodies. These antibodies are typically detected in lupus anticoagulant assays and tests for anticardiolipin antibodies. Most antiphospholipid antibodies are directed against several phospholipid-binding plasma proteins. The most common antigens are β₂-glycoprotein I and prothrombin. Immunoassays using these purified antigens are now available. In addition to being markers for thrombotic risk, antiphospholipid antibodies have been shown to directly contribute to hypercoagulability in animal models and in various in vitro studies. Prevention of recurrent venous thrombosis in patients with the antiphospholipid syndrome requires long-term anticoagulation. The optimal intensity of warfarin therapy is an ongoing issue, but most clinicians currently favor a target INR in the 2.0 to 3.0 range. In certain patients, antiphospholipid antibodies may interfere with determination of the INR, requiring other approaches to monitor and adjust the warfarin dose. Low-dose aspirin is typically recommended for primary prevention of thrombosis in asymptomatic patients with moderate to high levels of antiphospholipid antibodies, although strong supporting data are lacking.

Key Words: antiphospholipid • anticardiolipin • lupus anticoagulant • β2-glycoprotein I • thrombosis

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