Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome

Evidence may be insufficient to draw conclusions on the benefit or harm of using novel oral anticoagulants, warfarin or oral antiplatelet therapy or their combinations for the secondary prevention of recurrent thrombosis in antiphospholipid syndrome.

Comment: The quality of evidence is downgraded by imprecise results (few studies in each comparison).

Summary

A Cochrane review included 5 studies with a total of 419 subjects with antiphospholipid syndrome (APS). The duration of intervention ranged from 180 days to a mean of 3.9 years.

• Rivaroxaban vs. warfarin (one study, n=112): No thrombotic or major bleeding events were reported, but the study was not powered to detect such differences. Similar rates of clinically relevant non-major bleeding (RR 1.45, 95% CI 0.25 to 8.33) and minor bleeding (RR 1.21, 95% CI 0.51 to 2.83) were reported for patients receiving rivaroxaban and warfarin. There was also small benefit with rivaroxaban over warfarin in terms of quality of life health state measured at 180 days with the EQ-5D-5L 100 mm visual analogue scale (MD 7 mm, 95% CI 2.01 to 11.99) but not measured as health utility (MD 0.04, 95% CI −0.02 to 0.10 [on a scale from 0 to 1]).
• High-dose warfarin vs. standard warfarin (2 studies, n=223): There were no differences in the rates of any thrombotic events (RR 2.22, 95% CI 0.79 to 6.23) or major bleeding (RR 0.74, 95% CI 0.24 to 2.25) between the groups. Minor bleeding analyzed using the RR and any bleeding using the HR were more frequent in patients receiving high-intensity warfarin compared to the standard therapy (RR 2.55, 95% CI 1.07 to 6.07; and HR 2.03, 95% CI 1.12 to 3.68).
• Warfarin plus antiplatelet agent vs. single antiplatelet agent (one study, n=60) it was not possible to estimate the RR for stroke while regarding a major bleeding, a single event occurred in the single antiplatelet agent group.
• Warfarin plus antiplatelet vs. dual antiplatelet therapy (one study, n=40): the RR of the risk of stroke over 3 years of observation was 5.00 (95% CI 0.26 to 98.0).
• Dual antiplatelet vs. single antiplatelet therapy (one study, n=40): RR for stroke during one year of observation was 0.14 (95% CI 0.01 to 2.60).

Clinical comments

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Ədəbiyyat

1. Bala MM, Celinska-Lowenhoff M, Szot W et al. Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome. Cochrane Database Syst Rev 2017;10():CD012169.