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In Reply: We agree with Drs Wahl and Regnault that outcome data from patients with a single positive antiphospholipid antibody test may not be generalizable to patients with definite APS, as defined by the Sapporo criteria¹ or more recently proposed amendments to these criteria.² We address this issue in our review and qualify our recommendations for the use of aspirin or warfarin in the treatment of stroke to indicate that they apply to "patients with a first ischemic stroke and a single positive antiphospholipid antibody test result . . . ," reflecting the design of the Antiphospholipid Antibodies and Stroke Study.³ No randomized trials have evaluated different antithrombotic treatments in patients with stroke in whom APS was diagnosed according to the Sapporo criteria.

We also agree with Drs Wahl and Regnault that antibody type and titer influence the risk of thrombotic events in patients with antiphospholipid antibodies, and that higher-intensity warfarin may yet have . . . [Full Text of this Article]

Wendy Lim, MD; Mark Crowther, MD, MSc; John Eikelboom, MBBS
eikelbj@mcmaster.ca
McMaster University
Hamilton, Ontario

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