Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Dr Cabral states that our results
"contradict" our previous report showing a "high risk of stroke." Our prior
report1 was a case-control study of first
stroke in patients with aCL. Our current study looked at both LA and aCL in
predicting recurrent thrombo-occlusive events—these are different questions,
different populations, and different methodologies and, hence, not contradictory.
We did not intend to suggest that our results are applicable to all populations
at risk for, or that have experienced, stroke. As with most studies, our results
are most generalizable to patients similar to those eligible for inclusion.
Few young patients with stroke and established APS were included. Our report,
however, provides the largest randomized trial to date to evaluate the significance
of aPL status for recurrent stroke and the efficacy of warfarin. Given that
the vast majority of ischemic strokes are not from APS but rather have etiologies
more representative of those in the previous cohort, we stand by our conclusion
that our data may apply to the general stroke population. Exceptions have
not yet been identified through rigorous clinical trials.
Levine SR, Brey RL, Tilley BC, Triplett DA, Thompson JLP, Sacco RL, Mohr JP, for the APASS Investigators . Antiphospholipid Antibodies and Risk for Recurrent Vascular Events—Reply. JAMA. 2004;291(22):2701. doi:10.1001/jama.291.22.2702