International Scholarly Research Notices / 2014 / Article / Tab 1

Review Article

Review on Effectiveness of Primary Prophylaxis in aPLs with and without Risk Factors for Thrombosis: Efficacy and Safety

Table 1

Systematic review of primary prophylaxis in aPLs.

CategoryAuthor, yearStudy design Number of aPL measurementComparison/interventionResults/conclusion

RCTErkan et al., 2007 [29]RCT with parallel prospective cohortRCT = 98; cohort ≥2.6 weeks apart; observational 2.4 yearsRCT: ASA 81 mg daily ( ) versus placebo ( )(i) HR: 1.04 (95% CI: 0.69–1.56)
(ii) >60% of patients in RCT had SLE
(iii) In comparison to placebo, ASA was not effective in preventing thrombosis
Finazzi et al., 2005 [31]Randomized trial1093.6 yearsConventional intensity or ASA alone
High-intensity warfarin
Conventional group HR 2.18 (95% CI 0.92–5.15)
High-intensity group HR 1.97 (95% CI 0.92–5.15)
Erkan et al., 2002 [10]Cross-sectional56Not specifiedLogistic regression analysis (ASA and/or HCQ use)Probability of thrombotic event decreased in patients taking ASA +/− HCQ (HCQ only in patients with Connective tissue disease)—78% of patient had Connective tissue disease
Wahl et al., 2000 [30]Decision analysisObservation ASA anticoagulationIn aPL-positive SLE patients, benefit of primary prophylaxis with ASA outweighs risk
Willis et al., 2012 [74]Multiethnic, multicenter cohort (LUMINA)35Not specifiedComparison of SLAM-R scoresDecrease in SLAM-R after HCQ therapy strongly correlated with decreases in IFN- ( )
Petri, 1996 [27]Hopkins cohort study10012 monthsPredictors for thrombosis in SLE patients and effects of HCQ on thrombosisHigh anti-dsDNA and low C3, atherosclerosis (hypertension, hyperlipidemia, and elevated homocysteine)

ProspectiveGirón-González et al., 2004 [39]Prospective178>2.8–12 weeks apartASA 325 mg/d or
LMWH daily during high risk situations*
All patients received thromboprophylaxis during high risk situations; no thrombotic events occurred
Levine et al., 2002 [4]Prospective study22Not specifiedEffect of HCQ on the AnxA5-RA in aPL-positive patients Positive AnxA5-RA, triple aPL-positive, double aPL-positive, and single aPL-positive were observed in 87%, 69%, 15%,
and 15% of the aPL -positive patients
Pierangeli et al., 1997 [26]Prospective study100Not specifiedComparing the results of AnxA5 resistance assay before and after administration of HCQHCQ was found to be effective in reducing thrombosis events
Cervera et al., 2009 [55]Multicentre prospective study 10005 yearsMorbidity and mortality in patients with APS LDA can prevent thrombosis
Tarr et al., 2007 [32]Prospective27281
aPL-positive
≥2.6 weeks apartProphylaxis ( ) versus observation ( )**Lower incidence of thrombosis in prophylaxis group versus observation group (1/52 versus 2/29 had stroke or TIA)
Ruiz-Irastorza et al., 2006 [44]Prospective cohort2321Effect of antimalarial drugs in preventing thrombosis in SLE patients through a Cox regression-multiple-failure time survival analysis modelaPL positivity (HR 3.16, 95% CI 1.45–6.88)
Rubenstein et al., 2006 [42]Cohort study1795Not specifiedCapability of HCQ in reducing thrombosisHCQ was found to be effective

RetrospectiveHereng et al., 2008 [40]Retrospective103 (36% SLE or other Connective tissue disease) 64 months +/− 24
Unknown time interval between measurement
ASA ( ) versus observation ( ); HCQ in connective tissue disease(i) In ASA group, lower frequency of thrombotic events observed (12% versus 35.7% overall; 11% versus 4% in SLE, particularly in the SLE or AIT subgroups of patients)
(ii) 36% of patients had SLE
Ruffatti et al., 2009 [13]Retrospective 370 (35% SLE)56.3 months134 long-term prophylaxes with ASA
5 long-term prophylaxes with warfarin
48 prophylaxes only during period of high risk with ASA/heparin or both
Combination of high and long-term risk period of prophylaxis protective against thrombosis
Tektonidou et al., 2009 [36]Retrospective288.144 aPL-positive≥2–12 weeks apartAdjusted survival analysis (ASA 80–100 mg/d, HCQ)(i) HR per month: ASA 0.98 (95% CI: 0.96–0.99) and HCQ 0.99 (95% CI: 0.98–1.00)
(ii) Duration of use of ASA and HCQ associated with decreased thrombosis
Kaiser et al., 2009 [41]Retrospective1930.516 aPL-positive1Logistic regression analysis (HCQ use)(i) OR 0.63 (95% CI: 0.48–0.83)
(ii) HCQ protective against thrombosis
Mok et al., 2005 [37]Retrospective8311 yearsHCQ intake showed lower risk for thrombotic events (OR 0.21 95% CI: 0.06–0.81)
Broder and Putterman, 2013 [38]Retrospective study90Not specifiedLink between HCQ aPL and LAC levels19% of the study population showed persistent LAC+ and/or at least 1 aPL ≥ 40 U
Wallace et al., 1993 [28]Retrospective726 yearsLogistic regression analysis (HCQ use)

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