Letters Section Editor: Robert M.
Golub, MD, Senior Editor.
In Reply: Although the comments of Dr Santana and colleagues about the risk of venous thromboembolic events in Wegener granulomatosis should be taken into account when caring for these patients, our systematic review dealt with the treatment of ANCA-associated vasculitis (AAV) and not of its complications.
We agree with the need for a randomized controlled trial to assess the efficacy of anticoagulant therapy for the prevention of venous thromboembolic events in AAV. However, in our opinion the ideal anticoagulant agent to test should be heparin and not warfarin, as was suggested by Santana et al. Heparin compounds harbor well-known anti-inflammatory properties, some of them with potential impact on the abnormal inflammatory responses believed to occur in AAV.1 Thus,
heparin inhibits neutrophil adherence to endothelium, superoxide production,
and release of proteolytic enzymes. Moreover, heparin decreases the production of tumor necrosis factor α and other proinflammatory cytokines and interleukins.1
Bosch X, Guilabert A, Espinosa G, Mirapeix E. Treatment of ANCA-Associated Vasculitis—Reply. JAMA. 2007;298(23):2739-2740. doi:10.1001/jama.298.23.2740-a