Patient-level analysis of five international cohorts further confirms the efficacy of aspirin for the primary prevention of thrombosis in patients with antiphospholipid antibodies
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.
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In an individual patient analysis, the association between low-dose aspirin and reduced thrombosis in systemic lupus erythematosus patients with high-risk antiphospholipid antibody profile was independent of hydroxychloroquine use.
“In an individual patient analysis, this association was independent of the use of hydroxychloroquine (HCQ), suggesting that LDA offers additional benefit in this patient group.15”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [15]
A smaller individual patient meta-analysis derived from those studies found an association of similar magnitude.
“An association of similar magnitude was present in a smaller individual patient meta-analysis derived from these studies.15”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [15]
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- Authors
- Arnaud, L., Mathian, A., Devilliers, H., Ruffatti, A., Tektonidou, M., Forastiero, R., Pengo, V., Lambert, M., Lefevre, G., Martinez-Zamora, M. A., Balasch, J., Wahl, D., & Amoura, Z.
- Affiliations
- Inserm (FR)
- Sorbonne Université (FR)
- University of Padua (IT)
- National and Kapodistrian University of Athens (GR)
- Favaloro University (AR)
- Centre Hospitalier Universitaire de Lille (FR)
- Hospital Clínic de Barcelona (ES)
- Corresponding author
- Arnaud, Laurent
- ORCID
- Venue
- Autoimmunity Reviews
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 14
- Issue
- 3
- Pages
- 192-200
- ISSN
- 1568-9972 (ISSN-L)
- OpenAlex
- W2052413901
- Cited by
- 146
- References
- 30
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 20 · 2023: 8 · 2022: 12 · 2021: 10 · 2020: 13 · 2019: 17 · 2018: 14 · 2017: 13 · 2016: 12 · 2015: 13
- FWCI
- 10.50
- 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, low-dose aspirin, arterial thrombosis, venous thrombosis, systemic lupus erythematosus, hydroxychloroquine, individual patient data meta-analysis, thrombosis risk
- MeSH terms
- Aspirin, Humans, Primary Prevention, Risk Factors, Thrombosis, Cohort Studies, Treatment Outcome, Antibodies, Antiphospholipid
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