Clinical outcomes of patients receiving long-term fondaparinux for thrombotic antiphospholipid syndrome

IF 1.9 4区 医学 Q3 RHEUMATOLOGY Lupus Pub Date : 2024-09-17 DOI:10.1177/09612033241285225
Buse Bor, Andrew J Doyle, John K Bartoli-Abdou, Anthony Hackett, Victoria Collings, Fatima Omrani, Carl Foskett, Anne Wareing, Johanna Young, Karen A Breen, Beverley J Hunt
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Abstract

IntroductionVitamin-K antagonists (VKA) are considered the first-line anticoagulants for thrombotic antiphospholipid syndrome (TAPS), particularly with triple positivity or arterial events. However, thrombotic recurrence remains high despite anticoagulation and other clinical issues may arise. Long-term parenteral anticoagulants may therefore be considered, however little is known about the viability of fondaparinux in this setting.Materials and MethodsWe describe the efficacy and safety of long-term fondaparinux for TAPS (>3-months duration) treated at a single centre in the UK. Clinical features and the outcomes of recurrence and bleeding were reviewed using electronic patient records.Results46 patients were identified with history of either venous or arterial TAPS and a total 175 patient-years using fondaparinux (median duration 2.7 years/patient (IQR 1.4–4.8)). 43 (93%) had VKA as first-line anticoagulation with a median duration of 6.5 years (IQR 4.0 – 9.8). All patients received fondaparinux as second-to fourth-line anticoagulation. Thrombosis recurrence occurred in 1 (1%) patient (0.6 events/100-patient years). Major, clinically relevant non-major (CRNM) or minor bleeding occurred in 2 (7%), 5 (10.9%) and 8 (17.4%) patients respectively. Major/CRNM bleeding rates were 1.1 and 2.9 events/100-patient-years. Age >65years was associated with bleeding ( p = .047) and concurrent antiplatelets were associated with major/CRNM bleeding ( p = .011). Logistic regression showed increasing age was associated with bleeding (OR = 1.097, p = .009).ConclusionsWe suggest that fondaparinux may be used for TAPS when VKA is not appropriate. Thrombotic recurrence was infrequent, and the number of major bleeding events appeared comparable to conventional therapies.
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长期服用磺达肝癸治疗血栓性抗磷脂综合征患者的临床疗效
导言维生素-K拮抗剂(VKA)被认为是治疗血栓性抗磷脂综合征(TAPS)的一线抗凝药物,尤其是三联阳性或动脉事件。然而,尽管进行了抗凝治疗,血栓复发率仍然很高,而且还可能出现其他临床问题。因此,可以考虑使用长期肠外抗凝剂,但对磺达肝癸在这种情况下的可行性知之甚少。材料与方法我们描述了英国一家中心治疗 TAPS(持续 3 个月)的长期磺达肝癸的有效性和安全性。结果发现,46 名患者均有静脉或动脉 TAPS 病史,使用磺达肝癸的总时间为 175 年(中位数时间为 2.7 年/患者(IQR 1.4-4.8))。43名患者(93%)将 VKA 作为一线抗凝药,中位持续时间为 6.5 年(IQR 4.0 - 9.8)。所有患者均接受磺达肝癸作为二线至四线抗凝治疗。1例(1%)患者出现血栓复发(0.6次/100例患者年)。分别有 2(7%)、5(10.9%)和 8(17.4%)名患者出现大出血、临床相关性非大出血(CRNM)或轻微出血。大出血/CRNM出血率分别为1.1和2.9次/100名患者-年。年龄 65 岁与出血有关(p = .047),同时服用抗血小板药物与大出血/CRNM出血有关(p = .011)。逻辑回归显示,年龄的增加与出血有关(OR = 1.097,p = .009)。结论我们建议,在不适合使用 VKA 时,可将磺达肝癸用于 TAPS。血栓复发并不常见,大出血事件的数量与传统疗法相当。
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来源期刊
Lupus
Lupus 医学-风湿病学
CiteScore
4.20
自引率
11.50%
发文量
225
审稿时长
1 months
期刊介绍: The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…
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