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

Arnaud, Laurent; Mathian, Alexis; Devilliers, H.; Ruffatti, Amelia; Tektonidou, Maria G.; Forastiero, Ricardo; Pengo, Vittorio; Lambert, Marc; Lefèvre, Guillaume; Martínez-Zamora, María Ángeles; Balasch, Juan; Wahl, Denis; Amoura, Zahir

doi:10.1016/j.autrev.2014.10.019

Cited by 119 publications

(73 citation statements)

References 27 publications

(46 reference statements)

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“…The incidence of APS-events in the control group (0.62% per year) was practically the same as was described in the healthy Caucasian population (0.65% per year). [16] Moreover, the incidence of APS-events in the previously asymptomatic IgA-aB2GP1 carriers was 3.1% per year, which was similar to 3.18% per year described for untreated asymptomatic aPL-consensus carriers without any prophylactic treatment[27] and is also within the reported range (1.36–3.8%) described in previous studies assessing the risk of events in asymptomatic aPL-consensus carriers. [28–30] Therefore, isolated positivity of IgA-aB2GPI in asymptomatic patients who are negative for other aPL seems to be an independent risk factor to develop APS-events.…”

Section: Discussionsupporting

confidence: 79%

Incidence of thromboembolic events in asymptomatic carriers of IgA anti ß2 glycoprotein-I antibodies

et al. 2017

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BackgroundThe antiphospholipid syndrome (APS) is defined by simultaneous presence of vascular clinical events and antiphospholipid antibodies (aPL). The aPL considered as diagnostics are lupus anticoagulant and antibodies anticardiolipin (aCL) and anti-ß2 glycoprotein-I (aB2GP1). During recent years, IgA aB2GP1 antibodies have been associated with thrombotic events both in patients positive, and mainly negative for other aPL, however its value as a pro-thrombotic risk-factor in asymptomatic patients has not been well defined.ObjectiveTo test the role of IgA anti B2GP1 as a risk factor for the development of APS-events (thrombosis or pregnancy morbidity) in asymptomatic population with a 5-year follow-up.Methods244 patients isolated positive for anti-beta2-glycoprotein I IgA (Group-1 study) and 221 negative patients (Group-2 control) were studied. All the patients were negative for IgG and IgM aCL.ResultsDuring the follow-up, 45 patients (9.7%) had APS-events, 38 positive for IgA-aB2GP1 and 7 negative (15.6% vs 3.2%, p<0.001).The incidence rate of APS-events was 3.1% per year in IgA-aB2GP1 positive patients and 0.6% per year in the control group. Arterial thrombosis were the most frequent APS-events (N = 25, 55%) and were mainly observed in Group-1 patients (21 vs 4, p = 0.001). Multivariate analysis were shown as independent risk-factors for the development of APS-events, age, sex (men) and presence of IgA-aB2GP1 (odds ratio 5.25, 95% CI 2.24 to 12.32).ConclusionThe presence of IgA-aB2GP1 in people with no history of APS-events is the main independent risk factor for the development of these types of events, mainly arterial thrombosis.

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Section: Discussionsupporting

confidence: 79%

Incidence of thromboembolic events in asymptomatic carriers of IgA anti ß2 glycoprotein-I antibodies

et al. 2017

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“…In a prospective study of triple‐positive aPL carriers a 5.3% annual incidence of thromboembolism was observed, not significantly diminished using aspirin administered in a non‐controlled manner . In two meta‐analyses by Arnaud et al Low dose aspirin (LDA) protected from arterial but not venous events among asymptomatic aPL carriers . Furthermore, treatment with low dose aspirin (LDA, 75–100 mg) is recommended to carriers with high risk aPL profiles according to EULAR recommendations .…”

Section: Treatmentmentioning

confidence: 99%

The antiphospholipid syndrome – often overlooked cause of vascular occlusions?

Svenungsson

Antovič

2020

J Intern Med

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The antiphospholipid syndrome (APS) was fully recognized as a clinical entity in the early 1980s. Still, more than 30 years later, the epidemiology of APS is not well described, and furthermore, APS remains a challenge in terms of both diagnostic issues and clinical praxis involving a wide range of specialties. To date, there are no diagnostic criteria for APS. The present classification criteria rely on a combination of clinical manifestations and persistently positive tests for antiphospholipid antibodies (aPL). Clinical symptoms comprise vascular thrombosis, which can affect any vascular bed, including venous, microvascular and arterial vessels, and a set of pregnancy morbidities including early and late miscarriages, foetal death and preeclampsia. APS is more frequent among patients with other autoimmune diseases, and it is especially common in systemic lupus erythematosus (SLE). Importantly, APS symptoms can present in almost any medical specialty, but general knowledge and most previous clinical studies have essentially been confined to haematology, rheumatology and obstetrics/gynaecology. However, recent data demonstrate a relatively high prevalence of aPL also in patients from the general population who suffer from vascular occlusions or pregnancy complications. It is important that these patients are recognized by the general health care since APS is a treatable condition. This review aims to summarize the present knowledge on the history, pathogenesis, clinical manifestations and treatment of APS in order to urge a wide range of clinicians to consider comprehensive assessment of all patients where the diagnosis APS may be conceivable.

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“…Regarding the use of aspirin as primary prophylaxis, it is still controversial. Studies have shown that the use of aspirin significantly reduces the risk of first thrombosis in asymptomatic anti-PLs positive patients, patients with SLE, and patients with obstetric APS [21,22]. Laurent Arnaud and others conducted an analysis of patient-level data from five international cohorts to examine the effect of low-dose aspirin on the risk of first thrombotic event in patients with aPL antibodies.…”

Section: Treatment -Primary Prophylaxismentioning

confidence: 99%

“…After adjusting on cardiovascular risk factors, aPL antibody profiles, and the treatment with hydroxychloroquine, the risk of first thrombosis in those treated with aspirin was lower than the untreated cases. The use of aspirin was showed to exert protective effect against arterial thrombosis for patients with SLE (HR: 0.43 [95%CI: 0.20-0.94]) and asymptomatic aPL antibodies carriers (HR: 0.43 [95%CI: 0.20-0.93]) [21]. On the contrary, the Antiphospholipid Antibody Acetylsalicylic Acid (APLASA) trial-a randomized, placebo controlled study to determine the efficacy of aspirin in primary prevention of thrombosis in asymptomatic aPL positive patients-failed to demonstrate any benefit of aspirin [23].…”

Section: Treatment -Primary Prophylaxismentioning

confidence: 99%

An unusual case of heart attack

Young¹,

Ng²

2018

Hong Kong Bulletin on Rheumatic Diseases

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We reported a patient with antiphospholipid syndrome (APS) secondary to systemic lupus erythematosus (SLE) who suffered from myocardial infarction and graft occlusion after coronary artery bypass surgery. Our patient illustrates the impact of accelerated atherosclerosis in patients with SLE and APS and the importance of early institution of antithrombotic therapies. In this article, the treatment of APS is summarized. Although the main stay of treatment is anticoagulation, there is emerging evidence to support rituximab as an option for "refractory" cases of APS.

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

Cited by 119 publications

References 27 publications

Incidence of thromboembolic events in asymptomatic carriers of IgA anti ß2 glycoprotein-I antibodies

Incidence of thromboembolic events in asymptomatic carriers of IgA anti ß2 glycoprotein-I antibodies

The antiphospholipid syndrome – often overlooked cause of vascular occlusions?

An unusual case of heart attack

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