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Risk benefit analysis of warfarin in APS Ruiz-Irastorza et al. Arch Intern Med 2002; 162: 1164-8
66 pts with previous thrombosis & INR 3-4. Recurrent thrombosis 9.1/100 pt years (INRs 2--2.5 at time of event).
Risk of major bleed 6/100 pt years (Intracranial 1.5/100 pt years).
Risks similar to other groups of patients treated at lower target INRS.
The INR in APS patients- “a nightmare”
•
Day-day monitoring
Anticoagulant clinics concern re “high” INRs & some patient knows when INR is too low!
Clinical decisions
• When to stop?
• Pregnancy
• Thrombocytopenia - continue unless platelet count <70
• What to do when oral anticoagulation fails?
Secondary APS have changing polypharmacy (NSAIDs, antimalarials,
• INR affected by thromboplastin? (recomb relipidated TF)
• Self monitoring, different method, many not reliable in APS patients
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