DAPT Effective, Safe for Prophylaxis of Arterial Thrombosis in Antiphospholipid Syndrome
DAPT may be effective for the prophylaxis of recurrent of arterial thrombosis in patients with APS.
According to study data published in Rheumatology, dual antiplatelet therapy (DAPT) may be effective for the prophylaxis of recurrent arterial thrombosis in patients with antiphospholipid syndrome (APS).
Investigators conducted a retrospective cohort study of patients with APS at the Hokkaido University Hospital between 1990 and 2016. The prophylactic effects and safety of 4 treatment modalities were examined: warfarin monotherapy, antiplatelet monotherapy, warfarin and antiplatelet combination therapy, and DAPT. As primary end points, researchers captured thrombosis-free and adverse event-free survival periods. Adverse events were defined as severe bleeding and death. A total of 90 patients with APS were enrolled, of whom 81% were women. The mean observation period for patients was 8 years. Cerebral infarction was the most frequent incident thrombotic event at baseline, occurring in 90% of patients.
Thrombotic recurrence was observed in 40 patients over the study period, including 35 arterial and 5 venous thromboses. Recurrence rates were significantly lower among patients receiving DAPT compared with patients receiving warfarin monotherapy (P =.001). The recurrence rates per 100 patient-years were 11.58, 5.47, 3.72, and 1.81 for warfarin monotherapy, antiplatelet monotherapy, warfarin and antiplatelet combination therapy, and DAPT, respectively. According to Kaplan-Meier analyses, the 10-year recurrence-free survival rate was 62% for all patients. Serious adverse events (9 severe bleeding events and 14 deaths) were observed in 20 patients. However, there were no between-group differences in the rates of serious adverse events.
These data demonstrate the efficacy and safety of DAPT therapy in preventing thrombotic recurrence among patients with APS. Additional research with a larger and more diverse cohort of individuals is necessary to confirm these findings. However, clinicians may find these data useful in selecting appropriate treatment modalities for patients at risk for arterial thrombosis.
Ohnishi N, Fujieda Y, Hisada R, et al. Efficacy of dual antiplatelet therapy for preventing recurrence of arterial thrombosis in patients with antiphospholipid syndrome [published online November 30, 2018]. Rheumatology. doi:10.1093/rheumatology/key340