Is aspirin (acetylsalicylic acid) contraindicated in patients with Systemic Lupus Erythematosus (SLE)?

From the Guidelines

Aspirin is not contraindicated in patients with Systemic Lupus Erythematosus (SLE) and may be considered for primary prevention of cardiovascular disease (CVD). According to the 2019 update of the EULAR recommendations for the management of SLE 1, low-dose aspirin may reduce the risk for incident CVD in SLE. However, this benefit must be weighed against the potential bleeding hazard, as recent large studies in diabetics and elderly have shown that the benefits of aspirin for primary CVD prevention are counterbalanced by the larger bleeding hazard.

When considering aspirin use in SLE patients, several factors should be taken into account, including:

• The presence of antiphospholipid antibodies or other cardiovascular risk factors
• The patient's lipid levels and traditional risk factors for CVD
• The calculation of the 10-year CVD risk using the Systematic Coronary Risk Evaluation (SCORE)
• The potential for aspirin hypersensitivity or increased bleeding risk due to renal involvement or anticoagulant use

In general, low-dose aspirin may be considered for SLE patients with high cardiovascular risk, but the decision to use aspirin should be individualized based on the patient's specific manifestations, comorbidities, and risk factors, weighing the potential cardiovascular benefits against possible adverse effects 1.

From the Research

Aspirin Contraindication in SLE Patients

• Aspirin is not absolutely contraindicated in patients with Systemic Lupus Erythematosus (SLE), but its use requires careful consideration due to potential side effects and variable efficacy 2, 3, 4, 5, 6.
• Studies have shown that aspirin may have a suboptimal effect in some SLE patients, with 15% of patients exhibiting impaired response to aspirin 2.
• The use of aspirin in SLE patients may be associated with an increased risk of renal side effects, including sodium retention and reduction of the glomerular filtration rate, particularly in those with lupus nephritis 3, 4.
• High-dose aspirin may also increase the risk of hepatotoxic effects in SLE patients 3, 4.
• However, low-dose aspirin may have a therapeutic potential in patients with antiphospholipid syndrome (APS) and may be used in combination with hydroxychloroquine for the primary prevention of cardiovascular events in SLE patients 5, 6.

Aspirin Resistance in SLE Patients

• Aspirin resistance has been observed in a significant proportion of SLE patients, with one study reporting a prevalence of 19.2% 5.
• The presence of aspirin resistance in SLE patients may be influenced by various factors, including disease activity, body mass index, and the presence of anticardiolipin antibodies or positive lupus anticoagulant test results 5.

Clinical Implications

• The use of aspirin in SLE patients should be individualized, taking into account the potential benefits and risks, as well as the presence of any underlying conditions that may affect its efficacy or safety 2, 3, 4, 5, 6.
• Close monitoring of toxicity and regular assessment of disease activity and cardiovascular risk factors are essential in SLE patients receiving aspirin therapy 3, 4, 6.