Secondary prevention with antiplatelet medications in patients with antiphospholipid antibody-related stroke

• Published in: Scientific reports Vol. 15; no. 1; pp. 7282 - 8
• Main Authors: Yang, Wookjin, Chung, Matthew, Ha, Jiyeon, Kang, Dong-Wan, Lee, Eung-Joon, Jeong, Han-Yeong, Kim, Jeong-Min, Jung, Keun-Hwa, Lee, Seung-Hoon
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2025; Nature Publishing Group; Nature Portfolio
• Subjects: 692/699/1670/122/1928; 692/699/375/1370; 692/699/375/1370/534; Aged; Antibodies, Antiphospholipid - immunology; Anticoagulants; Anticoagulants - therapeutic use; Antiphospholipid antibodies; Antiphospholipid syndrome; Antiphospholipid Syndrome - complications; Antiphospholipid Syndrome - drug therapy; Antiplatelet therapy; Bleeding; Female; Hemorrhage; Hemorrhage - chemically induced; Humanities and Social Sciences; Humans; Ischemia; Ischemic stroke; Ischemic Stroke - prevention & control; Male; Middle Aged; multidisciplinary; Platelet Aggregation Inhibitors - therapeutic use; Prevention; Proportional Hazards Models; Retrospective Studies; Science; Science (multidisciplinary); Secondary prevention; Secondary Prevention - methods; Stroke; Stroke - drug therapy; Stroke - etiology; Stroke - prevention & control; Thromboembolism; Thrombosis; Transient ischemic attack; Warfarin; Warfarin - adverse effects; Warfarin - therapeutic use; Secondary prevention; Ischemic stroke; Hemorrhage; Thrombosis; Antiphospholipid syndrome
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-025-91739-w

Clinical guidelines recommend warfarin for patients with antiphospholipid syndrome (APS) and ischemic stroke; however, robust evidence is lacking. We investigated the clinical benefits of different categories of antithrombotic medications in ischemic stroke patients positive for antiphospholipid antibodies (aPLs) in real-world practice. We reviewed data from patients with ischemic stroke or transient ischemic attack who tested positive for aPLs. Based on their secondary preventive antithrombotic medications, patients were classified into antiplatelet and anticoagulant categories, and further into warfarin, single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), and direct oral anticoagulant groups. The outcome of interest was a composite of recurrent thrombosis and major bleeding events. Time-varying Cox proportional hazards model was used. Among 167 eligible patients, 28 experienced composite outcome events over 601.1 person-years. SAPT and DAPT demonstrated clinical benefits over warfarin (SAPT vs. warfarin, adjusted hazard ratio [95% confidence intervals], 0.24 [0.07–0.83]; DAPT vs. warfarin, 0.25 [0.08–0.81]). Notably, DAPT was advantageous regarding major bleeding (DAPT vs. warfarin, 0.10 [0.02–0.47]), while the risk of recurrent thrombotic events was comparable between the antiplatelet and warfarin groups. Antiplatelet therapy may be a safe and effective alternative to warfarin for secondary prevention of aPL- and APS-related stroke. Further prospective validation is required.