A systematic review of secondary thromboprophylaxis in patients with antiphospholipid antibodies
Abstract
OBJECTIVE: To systematically review the efficacy and safety data of different therapeutic approaches in patients with antiphospholipid antibodies (aPL) and thrombosis. METHODS: The Medline database and references from selected reports and review articles were used. Randomized controlled trials, prospective and retrospective cohort studies, and subgroup analysis (n > 15) that focused on the secondary thromboprophylaxis in patients with aPL were selected. RESULTS: Sixteen studies were selected. Patients with venous events and a single test for aPL showed a low recurrence rate while receiving oral anticoagulation at a target international normalized ratio (INR) of 2.0-3.0. Patients with stroke and a single positive aPL test had no increased risk compared with those without aPL. Recurrence rates in patients with definite antiphospholipid syndrome (APS) and previous venous thromboembolism were lower than in patients with arterial and/or recurrent events, both with and without therapy. Only 3.8% of recurrent events occurred at an actual INR >3.0. Mortality due to recurrent thrombosis was higher than mortality due to bleeding (18 patients versus 1 patient reported). CONCLUSION: For patients with definite APS, we recommend prolonged warfarin therapy at a target INR of 2.0-3.0 in APS patients with first venous events and >3.0 for those with recurrent and/or arterial events. For patients with venous thromboembolism or stroke and a single positive aPL test, we recommend further testing to determine if they have a persisting antibody. If they do not, the same therapy as for the general population should be used (warfarin at a target INR of 2.0-3.0 and low-dose aspirin, respectively).
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An earlier systematic literature review including mainly observational studies reported that recurrent events occurred more often in antiphospholipid syndrome patients treated with vitamin K antagonist target INR 2-3 compared with INR 3-4, but outcomes among patients with first arterial thrombosis were not analysed specifically.
“An earlier SLR including mainly observational studies reported that recurrent events occurred more often in patients with APS treated with VKA with a target INR of 2–3 compared with an INR of 3–4, but outcomes among patients with first arterial thrombosis were not analysed specifically.35”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [35]
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- Authors
- Ruiz‐Irastorza, G., Hunt, B. J., & Khamashta, M. A.
- Affiliations
- University of the Basque Country (ES)
- St Thomas' Hospital (GB)
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2007-11-29
- Volume
- 57
- Issue
- 8
- Pages
- 1487-1495
- ISSN
- 0893-7524 (ISSN-L)
- 1529-0123
- OpenAlex
- W2160198109
- Cited by
- 324
- References
- 40
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 12 · 2023: 11 · 2022: 6 · 2021: 10 · 2020: 19 · 2019: 20 · 2018: 14 · 2017: 16 · 2016: 28 · 2015: 27 · 2014: 20 · 2013: 19 · 2012: 27
- FWCI
- 2.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- antiphospholipid antibodies, antiphospholipid syndrome, warfarin, oral anticoagulation, international normalized ratio, venous thromboembolism, arterial thrombosis, stroke, recurrent thrombosis, bleeding risk, low-dose aspirin
- MeSH terms
- Anticoagulants, Aspirin, Humans, Platelet Aggregation Inhibitors, Thrombosis, Warfarin, Antiphospholipid Syndrome, Antibodies, Antiphospholipid, International Normalized Ratio
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