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One hundred patients(69 percent)had a total of 186 recurrences of thrombosis.The median time between the initial recurrences of thrombosis. The median time between the initial thrombosis and the first recurrence was 12 months(range,0.5 to 144 months).Treatment with high-intensity warfarin(producing an international normalized ratio of>3)with or without low-dose aspirin(75 mg per day)was significantly more effective(P<0.001 by the log-rank test)than treatment with low-intensity warfarin(producing an international normalized ration of<3)with or without low-dose aspirin or treatment with aspirin alone in preventing further thrombotic events (recurrence rates per patient-year,0.013,0.23,and 0.18,respectively).The rate of recurrence of thrombosis was highest(1.30 per patient-year)during the first six months after the cessation of warfarin therapy.Complications involving bleeding occurred in 29 patients during warfarin therapy and were severe in 7(0.071 and 0.017 occurrence per patient-year, respectively).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. |
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