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Войти в исследования Seminars in arthritis and rheumatism · 2026
Effectiveness and safety of primary thromboprophylaxis in antiphospholipid antibody carriers by serological 2023 ACR/EULAR domains.
СтатьяНазвание и аннотация: Перевод в очереди
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Cantera Estefanía Rodrigo, Gálvez Sánchez Rafael, Gorostidi Álvarez Irene, Cruz Barquín Héctor, García Ruiz Raquel, Herrero López Marina, Flores García José Antonio, Oviedo Madrid María, Abando Casuso María, García Ascacíbar Ariadna, Gabrie Rodríguez Ligia Gabriela, Yáñez San Segundo Lucrecia, López Hoyos Marcos, Domínguez-García Juan José, González Ponte María Luisa, González-Mesones Galán Belén, Irure Ventura Juan, Hernández Hernández José Luis, Martínez Taboada Víctor Manuel
Аннотация
INTRODUCTION: The 2023 ACR/EULAR antiphospholipid syndrome (APS) criteria reduced IgM weighting and introduced a category for isolated lupus anticoagulant (LA), creating uncertainty about primary thromboprophylaxis in aPL carriers with <3 laboratory points. This study evaluates efficacy and safety of antiplatelet therapy and predictive value of the new ACR/EULAR thrombotic risk profiles.
MATERIAL AND METHODS: All asymptomatic carriers of single or confirmed LA, anticardiolipin (aCL), or anti-β2-glycoprotein I antibodies (anti-β2GPI), between January 2018 and March 2024 were included (n = 985). Primary outcomes were thrombotic-free survival (TFS), grade ≥3 bleeding-free survival (BFS), and bleeding symptoms. Logistic and Cox regression models were applied, and Altman-Andersen method estimated the number needed to treat (NNT) and harm (NNH).
RESULTS: During a median follow-up of 2.84 [IQR 1,12-4,74] years, venous (VTE) and arterial (ATE) thromboses occurred in 4.6% and 4.1% of patients, respectively. Among the entire cohort, aspirin (ASA) improved TFS (HR 0.51; p = 0.001) without affecting BFS (HR 0.96; p = 0.81). P2Y12 inhibitors were associated with higher ATE (OR 13.17; p < 0.001) and minor bleeding (OR 4.875; p = 0.007). High-risk venous profiles predicted VTE (OR 2.42; p = 0.005). Among 458 carriers with <3 laboratory points, ASA remained protective (HR 0.53; p = 0.047) without increasing minor or major bleeding. P2Y12 inhibitors showed no benefit in TFS and were linked to decreased BFS (HR 4.211; p = 0.008).
CONCLUSIONS: Low-dose aspirin may lower thrombotic risk without increasing bleeding in asymptomatic aPL carriers, even in those with <3 laboratory points. P2Y12 inhibitors demonstrated reduced efficacy and an increased risk of bleeding, warranting confirmation in future studies.
MATERIAL AND METHODS: All asymptomatic carriers of single or confirmed LA, anticardiolipin (aCL), or anti-β2-glycoprotein I antibodies (anti-β2GPI), between January 2018 and March 2024 were included (n = 985). Primary outcomes were thrombotic-free survival (TFS), grade ≥3 bleeding-free survival (BFS), and bleeding symptoms. Logistic and Cox regression models were applied, and Altman-Andersen method estimated the number needed to treat (NNT) and harm (NNH).
RESULTS: During a median follow-up of 2.84 [IQR 1,12-4,74] years, venous (VTE) and arterial (ATE) thromboses occurred in 4.6% and 4.1% of patients, respectively. Among the entire cohort, aspirin (ASA) improved TFS (HR 0.51; p = 0.001) without affecting BFS (HR 0.96; p = 0.81). P2Y12 inhibitors were associated with higher ATE (OR 13.17; p < 0.001) and minor bleeding (OR 4.875; p = 0.007). High-risk venous profiles predicted VTE (OR 2.42; p = 0.005). Among 458 carriers with <3 laboratory points, ASA remained protective (HR 0.53; p = 0.047) without increasing minor or major bleeding. P2Y12 inhibitors showed no benefit in TFS and were linked to decreased BFS (HR 4.211; p = 0.008).
CONCLUSIONS: Low-dose aspirin may lower thrombotic risk without increasing bleeding in asymptomatic aPL carriers, even in those with <3 laboratory points. P2Y12 inhibitors demonstrated reduced efficacy and an increased risk of bleeding, warranting confirmation in future studies.