Anticoagulants for Vascular Behçet's Just in Case? Bad Idea

Anticoagulants don't help even the rare patients with Behçet disease who present with vascular symptoms, a retrospective study shows. Persistence with other treatments, though, is imperative.

Alibaz-Oner F, Karadeniz A,Ylmaz S, et al. BehÃ§et Disease With Vascular Involvement: Effects of Different Therapeutic Regimens on the Incidence of New Relapses. Medicine. 2015;94(6):e494 doi: 10.1097/MD.0000000000000494

EULAR recommends immunsuppressive agents only for vascular BehÃ§et disease (VBD), but many rheumatologists also add anticoagulants, and sometimes give only anticoagulants.

This retrospective study of Turkish rheumatologists found that most of them also added anticoagulants, but there was no benefit to doing so. Patients with anticoagulants only were worse off, and much more likely to have a second vascular event.

This study found that immunosuppressants should be used for more than two years, but most physicians are unwilling to do that. A major cause of relapse was early termination of immunsuppresant therapy.

EULAR guidelines have no recommendations for duration of treatment.

Patient noncompliance was another major cause of relapse.

Out of 936 patients with BehÃ§et disease, 260 (28%) had VBD. For half of these, vascular disease was the presenting sign. After the first vascular event, all got corticosteroids, 89% got immunosuppressants and 60% got anticoagulants. Median duration of immunosuppressant treatment was 22 months (range, 1-204) and median duration of anticoagulant treatment was 13 months (range, 1-204).

A second vascular event developed in 86 (33%) of patients, and adding anticoagulants provided no benefit. Among the patients taking only anticoagulants, 92% had a second vascular event.