• Keren Meir, Stanley Niznik, Orly Avnery, Adi Zoref-Lorenz, Nancy Agmon-Levin, and Martin H Ellis.
• School of Medicine, Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
• Am. J. Med. 2024 Oct 1.

BackgroundThrombosis in the antiphospholipid syndrome is still frequently treated with vitamin K antagonists with a target international normalized ratio of 2-3. Time in therapeutic range of international normalized ratio of ≥ 70% is considered optimal. Time in therapeutic range among antiphospholipid syndrome patients is not well documented and the clinical consequences of poor international normalized ratio control are uncertain.AimsTo determine the proportion of vitamin K antagonist -treated antiphospholipid syndrome patients achieving time in therapeutic range ≥ 70%, to define the features associated with poor control and to determine its association with thrombotic and bleeding events.MethodsThis medical records review included antiphospholipid syndrome patients treated with vitamin K antagonists, between 2012-2023. The proportion of patients achieving a time in therapeutic range≥ 70% was determined and thrombotic and bleeding events were compared between patients with time in therapeutic range ​​≥ 70% versus < 70%.Results67 antiphospholipid syndrome patients were studied. 29.9% achieved time in therapeutic range ≥ 70%. 9.1% of patients with 3 or more comorbidities achieved time in therapeutic range values ≥ 70% compared to 40% of patients with less than 3 comorbidities. Fewer recurrent arterial and overall thrombotic events occurred with time in therapeutic range ​​≥ 70%.ConclusionsA minority of antiphospholipid syndrome patients treated with vitamin K antagonist s achieve optimal anticoagulation and are at risk for recurrent thrombotic events, particularly arterial. Presence of multiple comorbidities is associated with poor international normalized ratio control. Careful monitoring of this patient population is warranted.Copyright © 2024. Published by Elsevier Inc.

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