Variability in the international normalised ratio (INR) in patients with antiphospholipid syndrome and positive lupus anticoagulant: should the INR targets be higher?
| Contribuinte(s) |
Calderon Ospina, Carlos Téllez Arévalo, Angélica María |
|---|---|
| Data(s) |
18/03/2016
|
| Resumo |
El síndrome antifosfolípido es un desorden autoinmune caracterizado por hipercoagulabilidad que requiere terapia anticoagulante como pilar fundamental, siendo la warfarina el tratamiento de elección en los casos que requieren manejo por largos periodos. Sin embargo, los pacientes con anticoagulante lúpico positivo representan un reto porque tienen mayor riesgo de presentar eventos trombóticos, sumado a que el seguimiento con el International Normalized Ratio (INR) no es confiable, ya que estos anticuerpos generan interferencia con las pruebas de laboratorio basadas en fosfolípidos, como es el caso del tiempo de protrombina (PT) con INR basal prolongado, incluso antes del inicio de la terapia anticoagulante. Por tal razón, se ilustra el caso de una paciente con síndrome antifosfolípido primario y anticoagulante lúpico positivo quien ha presentado múltiples episodios trombóticos, a pesar de recibir terapia anticoagulante. Además se hace una revisión de la literatura disponible y se postulan nuevas metas de INR en estos pacientes diferentes de las que se plantean actualmente. Antiphospholipid syndrome (APS) is an autoimmune disorder characterised by hypercoagulability requiring anticoagulant therapy as the basis, with warfarin as the treatment of choice in cases requiring long-term management. However, patients with positive lupus anticoagulant (LA) present a challenge because they have an increased risk of thrombotic events, in addition to the fact that the monitoring of the international normalised ratio (INR) is unreliable because these antibodies generate interference with the laboratory tests based on phospholipids, as is the case for prothrombin time (PT) with prolonged baseline INR, even before the start of anticoagulant therapy. For this reason, we present the case of a patient with primary APS and positive LA who had multiple thrombotic events despite receiving anticoagulant therapy. |
| Formato |
application/pdf |
| Identificador | |
| Idioma(s) |
spa |
| Publicador |
Facultad de Medicina |
| Direitos |
info:eu-repo/semantics/openAccess |
| Fonte |
instname:Universidad del Rosario reponame:Repositorio Institucional EdocUR 1. Arachchillage DJ, Cohen H. Use of new oral anticoagulants in antiphospholipid syndrome. Curr Rheumatol Rep 2013;15:331–9. 2 Ruiz-Irastorza G, Crowther M, Branch W, et al. Antiphospholipid syndrome. Lancet 2010;376:1498–509. 3 Crowl A, Schullo-Feulner A, Moon JY. A review of warfarin monitoring in antiphospholipid syndrome and lupus anticoagulant. Ann Pharmacother 2014;48:1479–83. 4 Chighizola C, Moia M, Meroni P. New oral anticoagulants in thrombotic antiphospholipid syndrome. Lupus 2014;23:1279–82. 5 Holbrook A, Schulman S, Witt DM, et al. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141:152–84. 6 Rosborough TK, Jacobsen JM, Shepherd MF. Factor X and factor II activity levels do not always agree in warfarin-treated lupus anticoagulant patients. Blood Coagul Fibrinolysis 2010;21:242–4. 7 Rosborough TK, Shepherd MF. Unreliability of international normalized ratio for monitoring warfarin therapy in patients with lupus anticoagulant. Pharmacotherapy 2004;24:838–42. 8 Ketha SS, Pruthi RK, McBane RD, et al. Lupus anticoagulant, warfarin, and alternative laboratory monitoring of anticoagulation. J Thromb Thrombolysis 2014;37:532–5. 9 Tripodi A, Chantarangkul V, Clerici M, et al. Laboratory control of oral anticoagulant treatment by the INR system in patients with the antiphospholipid syndrome and lupus anticoagulant. Results of a collaborative study involving nine commercial thromboplastins. Br J Haematol 2001;115:672–8. 10 Bijsterveld NR, Middeldorp S, Berends F, et al. Monitoring therapy with vitamin K antagonists in patients with lupus anticoagulant: effect on different tests for INR determination. J Thromb Thrombolysis 2000;9:263–9. 11 Cohen H, Machin S. Antithrombotic treatment failures in antiphospholipid syndrome: the new anticoagulants? Lupus 2010;19:486–91. 12 Erkan D, Aguiar CL, Andrade D, et al. 14th International Congress on Antiphospholipid Antibodies: task force report on antiphospholipid syndrome treatment trends. Autoimmun Rev 2014;13:685–96. 13 Bachmeyer C, Elalamy I. Rivaroxaban as an effective treatment for recurrent superficial thrombophlebitis related to primary antiphospholipid syndrome. Clin Exp Dermatol 2014;39:840–1. 14 Rivaroxaban in Thrombotic Antiphospholipid Syndrome [internet]. ClinicalTrials.gov; (cited 23 October 2014). https://clinicaltrials.gov/ct2/show/record/NCT02157272? term=antiphospholipid+syndrome&rank=11 15 Rivaroxaban for Antiphospholipid Antibody Syndrome [internet]. ClinicalTrials.gov; (cited 23 October 2014). https://clinicaltrials.gov/ct2/show/record/NCT02116036? term=antiphospholipid+syndrome&rank= 16 Sim SC, Ingelman-Sundberg M. Pharmacogenomic biomarkers: new tools in current and future drug therapy. Trends Pharmacol Sci 2011;32:72–81. |
| Palavras-Chave | #Toxicología #615.9 #Toxicología #Síndrome antifosfolípido #Tejido conectivo #Antiphospholipid syndrome #International normalised ratio (INR) #Anticoagulant therapy |
| Tipo |
info:eu-repo/semantics/bachelorThesis info:eu-repo/semantics/acceptedVersion |
