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To the Editor: We have several concerns about the study of Dr Levine and colleagues.¹ First, the high proportion of patients with aPL (41%) raises questions about the specificity of the tests they used. Second, the average age of the patients was significantly higher than that of those in most prior studies of antiphospholipid syndrome. Third, the authors achieved a relatively low mean international normalized ratio (INR) among the patients in the high-intensity group.

A single testing for aPL is inappropriate because persistence of aPL over time is considered a major requirement to establish the diagnosis of APS. In fact, Levine et al found an increased risk of death or thrombosis among patients testing positive for both aCL and LA; surprisingly, these patients comprised only 6.7% of the entire group.

Finally, the lack of different outcome between aPL-positive patients treated with aspirin or warfarin may actually support the idea that . . . [Full Text of this Article]

Guillermo Ruiz-Irastorza, MD, PhD
r.irastorza@euskalnet.net
Service and Department of Internal Medicine
Hospital De Cruces
University of the Basque Country
Bizkaia, Spain

Munther A. Khamashta, MD, FRCP, PhD; Graham R. V. Hughes, MD, FRCP
Lupus Research Unit
The Rayne Institute
St Thomas' Hospital
London, England

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