Prevalence of confirmed antiphospholipid syndrome in 18-50 years unselected patients with first unprovoked venous thromboembolism.

BACKGROUND: Antiphospholipid syndrome (APS) is an acquired thrombophilia disorder with prevalence not completely known in patients with first unprovoked venous thromboembolic events (VTE). Recent data suggest that the management of some APS patients should be different from that of patients with other thrombophilia. Our aim was to estimate the prevalence of APS in a community-based cohort of patients with a first unprovoked VTE. METHODS: We conducted a cross-sectional study analyzing data from our computer assisted oral anticoagulant dosage program. Data of all consecutive patients aged 18 to 50 years who were seen between January 1, 2002 and December 31, 2011 for a first proximal unprovoked VTE were extracted. The prevalence and main features of patients who fulfilled the Sapporo revised criteria for APS were collected. RESULTS AND DISCUSSION: A total of 524 incident patients aged 18 to 50 years were included in the anticoagulation clinic during the study period. Of them, 491 were tested for APS and 44 (9.0%; 95% confidence interval [CI]: 6.7-11.8) fulfilled APS criteria. Of 26 APS women, 8 (30.8%) were on combined oral contraceptive pill at the time of VTE, versus 108 (55.1%) in non-APS women (P = .02). No difference was observed between APS and non-APS patients in terms of gender or type of VTE. The prevalence of APS is high in young patients with a first unprovoked VTE. In the direct oral anticoagulant era, when and how to test for APS is challenging and deserves further investigation.

A simple method to identify patients on long-term warfarin who may derive the most benefit from new oral anticoagulants.

In many countries, new oral anticoagulants are only covered for patients with suboptimal anticoagulation control on vitamin K antagonists (VKAs). The quality of VKA management is often reported using the time in therapeutic range (TTR). We sought to predict a TTR 65% or less using a surrogate measure [number of changes in VKA dose and number of international normalized ratio (INR) tests] that could be easily determined by primary care physicians. This cross-sectional study included consecutive patients whose VKA therapy was managed in a specialized anticoagulation clinic. Patients were dichotomized according to their TTR in the past 6 months (TTR > or ≤ 65%). The ability of the number of INR tests and VKA dose changes to predict TTR group was assessed using receiver-operating characteristics (ROC) curve analysis. The analyses included 1381 patients with a median age of 63 years. The mean TTR was 81% (interquartile range 70-90) and 17.4% of patients had a TTR 65% or more. Based on the ROC curve, patients were stratified according to whether they had either 3 or more dose changes or 9 or more INR tests within the last 6 months. The sensitivity to identify patients with TTR 65% or less was 87% and the specificity was 63%. The number of dose changes and the number of INR tests might be used as indicators of TTR; they could offer a simple way for clinicians to identify patients who are good candidates for the new oral anticoagulants. However, external validation studies in different clinical settings are needed to confirm these findings.