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Anticardiolipin Antibodies and Hypercoagulability
- Matthew H. Liang, MD;
- Charles H. Hennekens, MD; and
- Meir J. Stampfer, MD
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IN RESPONSE:
We appreciate the comments of Drs. Anand and Hess. The data cited by Dr. Anand [1] suggest that when treatment is warranted, warfarin may be more effective than aspirin in preventing recurrent thrombotic events in patients with elevated antiphospholipid antibody levels. As he notes, the study was not designed to study that treatment. In our study, physicians with such elevated levels who were assigned to aspirin did not appear to have a lower risk for thrombosis than those in the placebo group.
Dr. Hess lists several potential reasons why we were not able to detect an association between anticardiolipin antibodies and risk for ischemic stroke. We do not believe that the results can be explained entirely by the selection criteria. Although potential participants were excluded if they had a history of stroke or transient ischemic attack, once randomized, patients were not excluded for any reason. Hence, those who subsequently had a transient ischemic attack were retained in the analysis. Moreover, few of the patients with pulmonary embolism or deep vein thrombosis had had previous venous thrombosis. Although an association between anticardiolipin antibodies and ischemic stroke cannot be ruled out, as we noted in our paper, the null findings are consistent with another prospective study among survivors of acute myocardial infarction [2].
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
