Hematology 2001 © 2001 The American Society of Hematology. Patients with spontaneous thromboembolism and the aPL syndrome should be treated with long-term oral anticoagulant therapy. Results of studies vary as to the recommended intensity of anticoagulant therapy. A retrospective study concluded that an international normalized ratio (INR) of > 3.0 was necessary to protect patients from recurrence of venous or arterial thrombosis.

Natl Med J India. 2003 Nov-Dec;16(6):311-6. Promotes an INR of 3-4.

Promotes an INR of greater than 3.0.

Last Updated: December 5, 2004 Based on the most recent evidence, a reasonable target for the international normalized ratio (INR) is 2.6-3 for a minimum of 6 months for a first thrombosis. Patients with recurrent thrombotic events while well maintained on the above regimen may require an INR of 3-4 and generally receive anticoagulation therapy for life. For severe or refractory cases, a combination of warfarin and aspirin may be used.

Indian Pediatrics 2001; 38: 1413-1416 Promotes an INR of greater that 3.0.

Promotes an INR of 3.5 or greater.

N. Engl. J. Med. 332:993-997 April 1995 Conclusions: The risk of recurrent thrombosis in patients with the antiphospholipid-antibody syndrome is high. Long-term anticoagulation therapy in which the international normalized ratio is maintained at or above 3 is advisable in these patients.

Published in the American Family Physician, Feb. 1999. A good general article, promotes an INR of 3-4 for APS patients.

Mehndiratta MM, Bhattacharya A, Gupta M, Khawaja GK, Puri V. Antiphospholipid antibodies syndrome in 'Stroke in young'. Neurol India 1999;47:122-6 Promotes an INR of greater than 3.0.

© 2003. The Journal of Rheumatology Publishing Company Limited. Supports an INR of greater than 3.0.

EMIS is grateful to Dr Paul Hewish for authoring this article. The final copy has passed peer review of the independent Mentor GP authoring team. ©EMIS 2004. Promotes an INR of 3.5 or greater.

Dr. Graham R.V. Hughes, MD FRCP The Rayne Institute St. Thomas' Hospital, London. The study led by Dr. Munther Khamashta and colleagues in the unit showed that over a 10 year period, neither aspirin nor low dose warfarin (INR

Postgraduate Medical Journal 2003;79:81-83 © 2003 Fellowship of Postgraduate Medicine. Promotes an INR of greater than 3.0.

Autoimmunity Reviews Volume 1, Issues 1-2 , February 2002, Pages 43-48. Take-home message: Hughes syndrome or APS is characterised by the presence of recurrent thrombosis and obstetric complications in association with aPL in patients' serum; β2GPI-dependent ELISA for aCL and LA are the only aPL recommended for routine testing and diagnosis of patients with APS due to their good level of standardisation and clinical correlations. Antibodies directed to other phospholipids or phospholipid-binding proteins (such as phosphatidylserine, β2GPI, prothrombin, protein C, etc.) are likely to have clinical significance although the test for their detection and clinical role are less well defined; Persistent positivity of aCL at medium to high levels and/or LA are required for the diagnosis of definite APS; APS is unique among thrombophilias in producing both arterial and venous thrombosis with similar frequency; Pregnancy complications are one of the hallmarks of APS. Fetal loss are most typical, but recurrent early miscarriage, prematurity due to placental insufficiency and pre-eclampsia are also frequent; A number of neurological diseases, such as MS-like disease, cognitive impairment and certain forms of migraine are being investigated as possible manifestations of Hughes syndrome; Current evidence, mostly from retrospective series, points to prolonged oral anticoagulation at a target INR 3.5 as the treatment of choice in aPL-associated thrombosis. Individual patients at lower risk of thrombosis or higher risk of bleeding may receive less intensive anticoagulation; Aspirin and heparin are recommended as treatments for pregnancy complications, although the optimal combination of both drugs is still to be defined. Recommendations vary among different groups; Corticosteroids do not play any role in treatment of manifestations of APS other than thrombocytopenia, haemolytic anaemia and catastrophic APS.

This article suggests an INR of 3 to 4 for patients with APS. Dr. Petri is one of the leading APS specialists and this webpage would be good to show your doctor if you are having a problem getting him/her to take you seriously that our INRs need to be higher.

Most patients with venous or arterial thrombosis and APS do well with conventional warfarin treatment (target INR 2.0 - 3.0). It is recommended that patients with recurrent thrombosis despite conventional doses of warfarin should maintain an INR of 3.0 - 4.0. This recommendation is based on one descriptive study and requires confirmation by randomised trials. The benefit of adding aspirin in arterial disease is not clear, and is likely to increase the risk of bleeding.

Clinical and Diagnostic Laboratory Immunology, November 1999, p. 775-782, Vol. 6, No. 6 1071-412X/99/$04.00+0 Copyright © 1999, American Society for Microbiology. All rights reserved. Anticoagulation with coumarins to an international normalized ratio (INR) of 2 to 3, standard after an episode of venous thromboembolism, appears inadequate in APS, and a target INR level of 2.5 to 4.0 or >3.0 has been suggested, although the risk of hemorrhage is increased.

(Circulation. 1996;93:1579-1587.) © 1996 American Heart Association, Inc. Promotes an INR of greater than 3.0.