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Efficacy of dual antiplatelet therapy for preventing recurrence of arterial thrombosis in patients with antiphospholipid syndrome

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Title: Efficacy of dual antiplatelet therapy for preventing recurrence of arterial thrombosis in patients with antiphospholipid syndrome
Authors: Ohnishi, Naoki Browse this author
Fujieda, Yuichiro Browse this author →KAKEN DB
Hisada, Ryo Browse this author
Nakamura, Hiroyuki Browse this author
Kato, Masaru Browse this author →KAKEN DB
Oku, Kenji Browse this author →KAKEN DB
Bohgaki, Toshiyuki Browse this author →KAKEN DB
Amengual, Olga Browse this author →KAKEN DB
Yasuda, Shinsuke Browse this author →KAKEN DB
Atsumi, Tatsuya Browse this author →KAKEN DB
Keywords: antiphospholipid syndrome (APS)
dual antiplatelet therapy (DAPT)
arterial thrombosis
venous thrombosis
prophylaxis
safety
Issue Date: Jun-2019
Publisher: Oxford University Press
Journal Title: Rheumatology
Volume: 58
Issue: 6
Start Page: 969
End Page: 974
Publisher DOI: 10.1093/rheumatology/key340
PMID: 30508199
Abstract: Objective. Warfarin is regarded as the standard treatment for preventing thrombotic events in APS, but the recurrence rate is still high. Dual antiplatelet therapy (DAPT) has been shown to be effective for the prevention of acute coronary syndrome or stroke. The objective of this study was to evaluate the efficacy of DAPT for the prevention of thrombosis recurrence in APS patients with history of arterial thrombosis. Methods. This retrospective cohort study of APS patients was conducted at Hokkaido University Hospital between 1990 and 2016. The secondary prophylactic effects and safety of warfarin monotherapy (Wf), antiplatelet monotherapy (AP), warfarin and antiplatelet combination therapy (Wf + AP) and DAPT were evaluated. The primary endpoints were set as thrombosis-free and adverse events-free survival period. Adverse events were defined as severe bleeding and death. Results. A total of 90 APS patients were enrolled. Thrombotic recurrence was found in 40 patients (35 arterial and 5 venous thromboses) and serious adverse events in 20 patients (9 severe bleeding events and 14 deaths). Kaplan-Meier analysis demonstrated a 10-year recurrence-free survival rate of 62%. The recurrence rate per 100 patient-years was as follows: Wf: 11.6, AP: 5.5, Wf: + AP: 3.7, DAPT: 1.8. We demonstrated that DAPT significantly reduced the rate of recurrence compared with Wf (log-rank P = 0.001). There were no significant differences in the rate of serious adverse events among the groups. Conclusion. DAPT might be considered as an effective and safe option for the prophylaxis of recurrent arterial thrombosis in APS.
Rights: This is a pre-copyedited, author-produced version of an article accepted for publication in Rheumatology following peer review. The version of record Volume 58, Issue 6, June 2019, Pages 969-974, is available online at: https://doi.org/10.1093/rheumatology/key340.
Type: article (author version)
URI: http://hdl.handle.net/2115/78264
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 藤枝 雄一郎

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