From the Guidelines
Aspirin can be used to treat Antiphospholipid Antibody Syndrome (APS), particularly for primary prevention in patients with positive antiphospholipid antibodies who haven't had thrombotic events, with low-dose aspirin (typically 81-100 mg daily) being a standard treatment.
Key Points to Consider
- The Antiphospholipid Antibody Acetylsalicylic Acid (APLASA) study, although small and insufficiently powered, found no reduction in the rate of first thrombotic events with low-dose (81 mg/d) aspirin over placebo in persistently aPL-positive asymptomatic individuals 1.
- For patients who have already experienced thrombosis, aspirin is usually combined with anticoagulation therapy such as warfarin, as seen in the WARSS/APASS collaboration which compared warfarin with aspirin for the prevention of a second stroke in patients with APL antibodies 1.
- In pregnant women with APS, low-dose aspirin plus prophylactic heparin is the recommended regimen to prevent pregnancy complications and thrombosis.
- Aspirin works by inhibiting platelet aggregation, which helps prevent the formation of blood clots that are a major risk in APS.
- While aspirin is generally well-tolerated, potential side effects include gastrointestinal irritation and bleeding, so taking it with food may help reduce stomach upset.
Important Considerations
- The effectiveness of aspirin in APS treatment may vary depending on the individual patient's risk factors and medical history.
- Treatment should always be personalized under medical supervision, as aspirin alone may not be sufficient for all APS patients, particularly those with a history of thrombosis.
- Ongoing management is crucial, as APS is a chronic condition requiring long-term treatment.
- The most recent and highest quality study, although limited by its small sample size, suggests that low-dose aspirin may not significantly reduce the risk of thrombotic events in asymptomatic aPL-positive individuals 1.
From the Research
Treatment of Antiphospholipid Antibody Syndrome (APS) with Aspirin
- Aspirin can be used as primary thromboprophylaxis in asymptomatic aPL carriers 2, 3, 4
- Aspirin may be used in combination with vitamin K antagonists (VKAs) in arterial thrombosis 2, 4
- The effectiveness of aspirin in preventing thrombosis in APS patients is still a topic of debate, with some studies questioning its effectiveness 3
- Aspirin appears to be as effective as moderate-intensity warfarin for preventing recurrent stroke in patients with prior stroke and a single positive test result for antiphospholipid antibody 5
Comparison with Other Treatments
- Anticoagulation with VKAs remains the cornerstone of therapy for thrombotic APS 2
- Direct oral anticoagulants (DOACs) may be considered in certain low-risk situations, although they are not recommended in patients with arterial thrombosis or triple positive aPL 2
- High-intensity warfarin is not more effective than moderate-intensity warfarin in preventing recurrent thrombosis 6, 5
Specific Patient Groups
- Patients with prior arterial thrombosis should receive VKA with or without low-dose aspirin 4
- Patients with venous thrombosis and negative lupus anticoagulant may be treated with DOACs, although more data are needed 4
- Asymptomatic patients with positive antiphospholipid antibodies without thrombosis or pregnancy complications may receive aspirin as primary prevention, especially when additional vascular risk factors are present 4