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We report a case of a 34-year-old Caucasian man with Evans's syndrome, first manifested in childhood as autoimmune thrombocytopenia. Besides anti-erythrocyte antibodies and platelet-associated immunoglobulins, this patient's serum showed also the presence of antiphospholipid-protein antibodies detected by coagulometric (lupus anticoagulant) as well as immunoenzymatic methods (anticardiolipin, antiprothrombin, and anti-Β2-glycoprotein I antibodies). Over 25 years of clinical observation the patient never experienced any thromboembolic events. We suggest that in the pathogenesis of Evans's syndrome and related disorders a major role is played by an autoimmune reaction with a predilection to various cell phospholipid-containing membrane structures, possibly damaged by a yet unknown primary insult. The significance of these various antiphospholipid-protein antibodies as predictors of thromboembolic complications in such patients remains, however, to be established. [ABSTRACT FROM AUTHOR]

Background: Development of clinical practice guidelines involves making trade-offs between desirable and undesirable consequences of alternative management strategies. Although the relative value of health states to patients should provide the basis for these trade-offs, few guidelines have systematically summarized the relevant evidence. We conducted a systematic review relating to values and preferences of patients considering antithrombotic therapy.Methods: We included studies examining patient preferences for alternative approaches to antithrombotic prophylaxis and studies that examined, in the context of antithrombotic prophylaxis or treatment, how patients value alternative health states and experiences with treatment. We conducted a systematic search and compiled structured summaries of the results. Steps in the process that involved judgment were conducted in duplicate.Results: We identified 48 eligible studies. Sixteen dealt with atrial fibrillation, five with VTE, four with stroke or myocardial infarction prophylaxis, six with thrombolysis in acute stroke or myocardial infarction, and 17 with burden of antithrombotic treatment.Conclusion: Patient values and preferences regarding thromboprophylaxis treatment appear to be highly variable. Participant responses may depend on their prior experience with the treatments or health outcomes considered as well as on the methods used for preference elicitation. It should be standard for clinical practice guidelines to conduct systematic reviews of patient values and preferences in the specific content area. [ABSTRACT FROM AUTHOR]