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June 9, 2004

Antiphospholipid Antibodies and Risk for Recurrent Vascular Events—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(22):2701. doi:10.1001/jama.291.22.2702

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.

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