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Autoimmun Rev. 2015 Mar;14(3):192-200. doi: 10.1016/j.autrev.2014.10.019. Epub 2014 Oct 22.

Patient-level analysis of five international cohorts further confirms the efficacy of aspirin for the primary prevention of thrombosis in patients with antiphospholipid antibodies.

Author information

1
AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Institut E3M, Department of Internal Medicine & French National Reference Center For Systemic Lupus and Antiphospholipid Syndrome, F-75013, Paris; Inserm UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, F-75013 Paris, France. Electronic address: Laurent.arnaud@psl.aphp.fr.
2
AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Institut E3M, Department of Internal Medicine & French National Reference Center For Systemic Lupus and Antiphospholipid Syndrome, F-75013, Paris; Sorbonne Universités, UPMC Univ Paris 06, F-75013 Paris, France.
3
Service de médecine interne et maladies systémiques, Dijon, France.
4
Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy.
5
First Department of Internal Medicine, School of Medicine, National University of Athens, Athens, Greece.
6
Department of Physiology, Favaloro University, Buenos Aires, Argentina.
7
Clinical Cardiology, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
8
Internal Medicine Department, Universitary Hospital, Lille, France.
9
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.
10
Nancy University Hospital, Université de Lorraine & INSERM U1116, Vandœuvre-Les-Nancy, France.

Abstract

We performed an individual patient meta-analysis to determine whether aspirin has a significant protective effect on the risk of first thrombosis among patients with antiphospholipid antibodies (aPL). Five international cohort studies with available individual patient-level data, reporting on primary prophylaxis with continuous treatment with low-dose aspirin in patients with aPL were included. The main outcome was the occurrence of a first thrombotic in patients with aPL treated with low-dose aspirin compared to those not treated with low-dose aspirin. Pooled Hazard Ratios (HRs) and 95%CIs were calculated using frailty models. We pooled data from 497 subjects and 79 first thrombotic events (3469 patient-years of follow-up). After adjustment on cardiovascular risk factors, aPL profiles, and treatment with hydroxychloroquine, the HR for the risk of a first thrombosis of any type in aPL carriers treated with low-dose aspirin versus those not treated with aspirin was 0.43 (95%CI 0.25-0.75). Subgroup analysis showed a protective effect of aspirin against arterial (HR: 0.43 [95%CI: 0.20-0.93]) but not venous (HR: 0.49 [95%CI: 0.22-1.11]) thrombosis. Subgroup analysis according to underlying disease revealed a protective effect of aspirin against arterial thrombosis for systemic lupus erythematosus (SLE) (HR: 0.43 [95%CI: 0.20-0.94]) and asymptomatic aPL carriers (HR: 0.43 [95%CI 0.20-0.93]). We found no independent protective effect of hydroxychloroquine. This individual patient data meta-analysis shows that the risk of first thrombotic event as well of first arterial thrombotic event is significantly decreased among SLE patients and asymptomatic aPL individuals treated by low-dose aspirin.

KEYWORDS:

Antiphospholipid antibodies; Aspirin; Meta-analysis; Primary prevention; Thrombosis

PMID:
25461472
DOI:
10.1016/j.autrev.2014.10.019
[Indexed for MEDLINE]

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