Thomas L Ortel1,2, Sreelatha Meleth3, Diane Catellier3, Mark Crowther4, Doruk Erkan5, Paul R Fortin6, David Garcia7, Nana Haywood3, Andrzej S Kosinski8, Steven R Levine9,10, Michael J Phillips3, Nedra Whitehead3. 1. Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA. 2. Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA. 3. RTI International, Research Triangle Park, North Carolina, USA. 4. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 5. Barbara Volcker Center for Women and Rheumatic Diseases, Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA. 6. Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada. 7. Division of Hematology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA. 8. Department of Biostatistics and Bioinformatics, Duke University Medical Center, and Duke Clinical Research Institute, Durham, North Carolina, USA. 9. Departments of Neurology and Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA. 10. Department of Neurology, Kings County Hospital Center, Brooklyn, New York, USA.
Abstract
BACKGROUND: Patients with antiphospholipid antibodies (aPL) and thromboembolism (TE) are at risk for recurrent TE. Few studies, however, distinguish patients based on the initial event. OBJECTIVES: We performed a systematic review and meta-analysis to investigate patients with aPL and venous TE (VTE), provoked or unprovoked, and patients with arterial TE (ATE). PATIENTS/ METHODS: We conducted searches in PubMed, CINAHL, Cochrane, and EMBASE. Inclusion criteria were prospective trials or cohort studies investigating patients with aPL and ATE or VTE. Excluded studies did not provide estimated recurrence rates, did not specify whether the incident event was ATE or VTE, included patients with multiple events, or included <10 patients. Two-year summary proportions were estimated using a random effects model. RESULTS: Ten studies described patients with VTE, 2 with ATE, and 5 with VTE or ATE. The 2-year proportion for recurrent TE in patients with VTE who were taking anticoagulant therapy was 0.054 (95% confidence interval [CI], 0.037-0.079); the 2-year proportion for patients not taking anticoagulant therapy was 0.178 (95% CI, 0.150-0.209). Most studies did not distinguish whether VTE were provoked or unprovoked. The 2-year proportion for recurrent TE in patients with ATE who were taking anticoagulant therapy was 0.220 (95% CI, 0.149-0.311); the 2-year proportion for patients taking antiplatelet therapy was 0.216 (95% CI, 0.177-0.261). CONCLUSIONS: Patients with aPL and ATE may benefit from a different antithrombotic approach than patients with aPL and VTE. Prospective studies with well-defined cohorts with aPL and TE are necessary to determine optimal antithrombotic strategies.
BACKGROUND:Patients with antiphospholipid antibodies (aPL) and thromboembolism (TE) are at risk for recurrent TE. Few studies, however, distinguish patients based on the initial event. OBJECTIVES: We performed a systematic review and meta-analysis to investigate patients with aPL and venous TE (VTE), provoked or unprovoked, and patients with arterial TE (ATE). PATIENTS/ METHODS: We conducted searches in PubMed, CINAHL, Cochrane, and EMBASE. Inclusion criteria were prospective trials or cohort studies investigating patients with aPL and ATE or VTE. Excluded studies did not provide estimated recurrence rates, did not specify whether the incident event was ATE or VTE, included patients with multiple events, or included <10 patients. Two-year summary proportions were estimated using a random effects model. RESULTS: Ten studies described patients with VTE, 2 with ATE, and 5 with VTE or ATE. The 2-year proportion for recurrent TE in patients with VTE who were taking anticoagulant therapy was 0.054 (95% confidence interval [CI], 0.037-0.079); the 2-year proportion for patients not taking anticoagulant therapy was 0.178 (95% CI, 0.150-0.209). Most studies did not distinguish whether VTE were provoked or unprovoked. The 2-year proportion for recurrent TE in patients with ATE who were taking anticoagulant therapy was 0.220 (95% CI, 0.149-0.311); the 2-year proportion for patients taking antiplatelet therapy was 0.216 (95% CI, 0.177-0.261). CONCLUSIONS:Patients with aPL and ATE may benefit from a different antithrombotic approach than patients with aPL and VTE. Prospective studies with well-defined cohorts with aPL and TE are necessary to determine optimal antithrombotic strategies.
Authors: Kristina Vrotniakaite-Bajerciene; Tobias Tritschler; Katarzyna Aleksandra Jalowiec; Helen Broughton; Justine Brodard; Naomi Azur Porret; Alan Haynes; Alicia Rovo; Johanna Anna Kremer Hovinga; Drahomir Aujesky; Anne Angelillo-Scherrer Journal: J Clin Med Date: 2022-07-19 Impact factor: 4.964