Efficacy of aspirin for the primary prevention of thrombosis in patients with antiphospholipid antibodies: an international and collaborative meta-analysis
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.
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In asymptomatic antiphospholipid antibody carriers with a high-risk profile, low-dose aspirin reduces the risk of first thrombosis by about half compared with no low-dose aspirin, based on a meta-analysis of seven observational studies of 460 carriers.
“Use of LDA for primary prophylaxis is supported by results of a meta-analysis of seven observational studies of 460 asymptomatic aPL carriers that found the risk of first thrombosis to be reduced by half in those who used LDA versus those who did not use LDA.14”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [14]
In patients with systemic lupus erythematosus and a high-risk antiphospholipid antibody profile, low-dose aspirin reduces first thrombosis by almost half compared with no low-dose aspirin, without major bleeding, based on a subanalysis of eight mostly observational studies.
“Treatment with LDA for patients with SLE and high-risk aPL profile is supported by a subanalysis of eight studies, mostly observational, in a meta-analysis.14 In this analysis, risk of first thrombosis was reduced by almost half among patients treated with LDA versus patients not treated, without major bleeding events.”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [14]
In non-pregnant women with a history of obstetric antiphospholipid syndrome only, the pooled odds ratio for first thrombosis associated with low-dose aspirin use was 0.25 (95% CI 0.10 to 0.62), from a meta-analysis of five observational studies.
“The primary prevention of thrombosis with LDA in women with a history of obstetric APS without SLE was addressed in a meta-analysis including five observational studies.14 The pooled OR for first thrombosis associated with use of LDA was 0.25 (95% CI 0.10 to 0.62).”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [14]
In antiphospholipid antibody carriers, a recent meta-analysis supported a protective role of low-dose aspirin for primary prophylaxis against thrombosis in the subgroup of carriers who had SLE.
“In aPL carriers, a recent meta-analysis supported a protective role of low-dose aspirin for primary prophylaxis against thrombosis in the subgroup of aPL carriers who had SLE”
From 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus (2019) · cites this paper as [135]
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References 55 · Cited by 215
- Authors
- Arnaud, L., Mathian, A., Ruffatti, A., Erkan, D., Tektonidou, M., Cervera, R., Forastiero, R., Pengo, V., Lambert, M., Martinez-Zamora, M. A., Balasch, J., Zuily, S., Wahl, D., & Amoura, Z.
- Affiliations
- Inserm (FR)
- University of Padua (IT)
- Hospital for Special Surgery (US)
- National and Kapodistrian University of Athens (GR)
- Hospital Clínic de Barcelona (ES)
- Favaloro University (AR)
- Centre Hospitalier Universitaire de Lille (FR)
- Corresponding author
- Arnaud, Laurent
- ORCID
- Venue
- Autoimmunity Reviews
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 13
- Issue
- 3
- Pages
- 281-291
- ISSN
- 1568-9972 (ISSN-L)
- OpenAlex
- W2037108451
- Cited by
- 215
- References
- 55
- Citations by year
- 2026: 6 · 2025: 16 · 2024: 25 · 2023: 16 · 2022: 17 · 2021: 14 · 2020: 16 · 2019: 25 · 2018: 19 · 2017: 22 · 2016: 7 · 2015: 14 · 2014: 18
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Autoimmunity Reviews (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- aspirin, antiphospholipid antibodies, arterial thrombosis, venous thrombosis, systemic lupus erythematosus, low-dose aspirin, antiplatelet therapy
- MeSH terms
- Aspirin, Hemorrhage, Humans, Lupus Erythematosus, Systemic, Risk Factors, Thrombosis, Antiphospholipid Syndrome, Antibodies, Antiphospholipid
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