Format

Send to

Choose Destination
Autoimmun Rev. 2014 Mar;13(3):281-91. doi: 10.1016/j.autrev.2013.10.014. Epub 2013 Nov 2.

Efficacy of aspirin for the primary prevention of thrombosis in patients with antiphospholipid antibodies: an international and collaborative meta-analysis.

Author information

1
Department of Internal Medicine, French National Reference Center for Systemic Lupus and Antiphospholipid Syndrome, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 bd de l'hôpital, 75013 Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S 945, Paris, France; Université Pierre et Marie Curie, UPMC Univ Paris 06, Paris, France. Electronic address: Laurent.arnaud@psl.aphp.fr.
2
Department of Internal Medicine, French National Reference Center for Systemic Lupus and Antiphospholipid Syndrome, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 47-83 bd de l'hôpital, 75013 Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S 945, Paris, France; Université Pierre et Marie Curie, UPMC Univ Paris 06, Paris, France.
3
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy.
4
Hospital for Special Surgery, Weill Cornell Medical College, New York, USA.
5
First Department of Internal Medicine, School of Medicine, National University of Athens, Athens, Greece.
6
Department of Autoimmune Diseases, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Catalonia, Spain.
7
Department of Physiology, Favaloro University, Buenos Aires, Argentina.
8
Clinical Cardiology, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
9
Internal Medicine Department, Universitary Hospital, Lille, France.
10
Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
11
Nancy University Hospital, Université de Lorraine, INSERM U961, Vandœuvre-Les-Nancy, France.

Abstract

We performed a meta-analysis to determine whether aspirin has a significant protective effect on risk of first thrombosis among patients with antiphospholipid antibodies (aPL+). Observational and interventional studies identified from the Medline, Embase and Cochrane databases were selected if they assessed the incidence of first thrombosis in aPL+ patients treated with aspirin versus those without. Pooled effect estimates were obtained using a random-effects model. Of 1211 citation retrieved, 11 primary studies (10 observational and 1 interventional) met inclusion criteria, including a total of 1208 patients and 139 thrombotic events. The pooled odds ratio (OR) for the risk of first thrombosis in patients treated with aspirin (n=601) was 0.50 (95%CI: 0.27 to 0.93) compared to those without aspirin (n=607), with significant heterogeneity across studies (I(2)=46%, p=0.05). Subgroup analysis showed a protective effect of aspirin against arterial (OR: 0.48 [95%CI: 0.28-0.82]) but not venous (OR: 0.58 [95% CI: 0.32-1.06]) thrombosis, as well as in retrospective (OR: 0.23 [0.13-0.42]) but not prospective studies (OR: 0.91 [0.52-1.59]). Subgroup analysis according to underlying disease revealed a significant protective effect of aspirin for asymptomatic aPL+ individuals (OR: 0.50 [0.25-0.99]), for systemic lupus erythematosus (SLE) (OR: 0.55 [0.31-0.98]) and obstetrical antiphospholipid syndrome (APS) (OR: 0.25 [0.10-0.62]). This meta-analysis shows that the risk of first thrombotic event is significantly decreased by low dose aspirin among asymptomatic aPL individuals, patients with SLE or obstetrical APS. Importantly, no significant risk reduction was observed when considering only prospective studies or those with the best methodological quality.

KEYWORDS:

Antiphospholipid antibodies; Aspirin; Meta-analysis; Thrombosis

PMID:
24189281
DOI:
10.1016/j.autrev.2013.10.014
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center