We read with great interest the comprehensive Review by Bello et al. published in Nature Reviews Rheumatology1. The authors stated that four retrospective studies have shown that the addition of anticoagulation to immunosuppressants does not seem to significantly reduce the recurrence of vascular events in Behçet syndrome compared with treatment with DMARDs alone. However, in our study2, which is one of the studies cited by the authors, recurrent venous thromboembolism was statistically significantly lower in the group treated with immunosuppressants plus anticogulation than in the group treated with immunosuppressants alone. Also, some case reports3 and a 2021 study4 report successful prevention of recurrence of venous thromboembolism with anticoagulation in these patients.

Thromboinflammation is the main mechanism underlying the vascular complications of Behçet syndrome. Thus, immunosuppressives are the mainstay of management. However, as previous studies revealed, there is a possibility of hypercoagulation and thrombophilia in these patients5,6,7,8. Therefore, adding anticoagulants might help to lower the risk of thrombosis in Behçet syndrome.