EXPRESS: Does anticoagulation in combination with immunosuppressive therapy prevent recurrent thrombosis in Behçet's Disease?

Vascular involvement in Behçet's Disease (BD) occurs in up to 50% of patients. The main mechanism of thrombosis is inflammation. Thus, immunosuppressants (IS) are the mainstay of therapy, and adding anticoagulants (AC) is controversial. In daily practice, we observed that patients who receive AC in combination with IS experience less recurrent thrombosis and decided to retrospectively investigate our Behçet's Disease patients. We hypothesized that adding anticoagulants to immunosuppressive therapy may lower the risk of recurrent thrombosis. Treatment at the time of first or recurrent thrombotic events was recorded. Events under the only IS and IS+AC treatments were compared. There were 40 patients (33 males). The most common types of first vascular events were deep vein thrombosis (77.5%) followed by pulmonary embolism (PE) (52.5%). One patient didn't receive any treatment. Among the 39 patients, 32 received glucocorticoid and at least one of the azathioprine, or cyclophosphamide, anti-TNF, 5 received monotherapy with azathioprine, 1 received monotherapy with corticosteroid, and the remaining 1 received monotherapy with cyclophosphamide. 22 patients (55%), experienced 27 recurrent venous thromboembolism (VTE) events. 2 (7.4%) events while only on AC, 2 (7.4%) events while on AC+IS, and 15 (55.5%) events occurred while on only IS. 8 (19.6%) patients were not receiving any treatment during relapses. The recurrence rate was statistically significantly lower in the IS+AC treatment group compared to IS alone. In conclusion, immunosuppressants are the mainstay of treatment for BD, adding anticoagulants may help to lower the recurrence risk of thrombotic events.