Yang Wookjin, Chung Matthew, Ha Jiyeon, Kang Dong-Wan, Lee Eung-Joon, Jeong Han-Yeong, Kim Jeong-Min, Jung Keun-Hwa, Lee Seung-Hoon
Department of Neurology, Asan Medical Center, Seoul, Republic of Korea.
Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Sci Rep. 2025 Mar 1;15(1):7282. 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.
临床指南推荐对华法林用于抗磷脂综合征（APS）和缺血性卒中患者；然而，缺乏有力证据。我们在实际临床中研究了不同类别抗血栓药物对抗磷脂抗体（aPLs）阳性的缺血性卒中患者的临床益处。我们回顾了缺血性卒中或短暂性脑缺血发作且aPLs检测呈阳性患者的数据。根据其二级预防抗血栓药物，患者被分为抗血小板和抗凝类别，进一步分为华法林组、单药抗血小板治疗（SAPT）组、双联抗血小板治疗（DAPT）组和直接口服抗凝剂组。感兴趣的结局是复发性血栓形成和大出血事件的复合情况。采用了时变Cox比例风险模型。在167例符合条件的患者中，在601.1人年期间有28例发生了复合结局事件。SAPT和DAPT相较于华法林显示出临床益处（SAPT与华法林相比，调整后的风险比[95%置信区间]为0.24[0.07 - 0.83]；DAPT与华法林相比，为0.25[0.08 - 0.81]）。值得注意的是，在大出血方面DAPT具有优势（DAPT与华法林相比，为0.10[0.02 - 0.47]），而抗血小板组和华法林组之间复发性血栓形成事件的风险相当。抗血小板治疗可能是华法林用于aPL和APS相关卒中二级预防的一种安全有效的替代方法。还需要进一步的前瞻性验证。
