Secondary prevention with antiplatelet medications in patients with antiphospholipid antibody-related stroke
Abstract 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 antiphospho...
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Nature Portfolio
2025-03-01
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| Online Access: | https://doi.org/10.1038/s41598-025-91739-w |
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| author | Wookjin Yang Matthew Chung Jiyeon Ha Dong-Wan Kang Eung-Joon Lee Han-Yeong Jeong Jeong-Min Kim Keun-Hwa Jung Seung-Hoon Lee |
| author_facet | Wookjin Yang Matthew Chung Jiyeon Ha Dong-Wan Kang Eung-Joon Lee Han-Yeong Jeong Jeong-Min Kim Keun-Hwa Jung Seung-Hoon Lee |
| author_sort | Wookjin Yang |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-e6f517ebd02d48fba0c720f9baea674e |
| institution | DOAJ |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj-art-e6f517ebd02d48fba0c720f9baea674e2025-08-20T03:04:11ZengNature PortfolioScientific Reports2045-23222025-03-011511810.1038/s41598-025-91739-wSecondary prevention with antiplatelet medications in patients with antiphospholipid antibody-related strokeWookjin Yang0Matthew Chung1Jiyeon Ha2Dong-Wan Kang3Eung-Joon Lee4Han-Yeong Jeong5Jeong-Min Kim6Keun-Hwa Jung7Seung-Hoon Lee8Department of Neurology, Asan Medical CenterDepartment of Neurology, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Neurology, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Neurosurgery, Seoul National University Bundang HospitalDepartment of Neurology, Seoul National University Hospital, Seoul National University College of Medicine Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical CenterDepartment of Neurology, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Neurology, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Neurology, Seoul National University Hospital, Seoul National University College of MedicineAbstract 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.https://doi.org/10.1038/s41598-025-91739-wAntiphospholipid syndromeHemorrhageIschemic strokeSecondary preventionThrombosis |
| spellingShingle | Wookjin Yang Matthew Chung Jiyeon Ha Dong-Wan Kang Eung-Joon Lee Han-Yeong Jeong Jeong-Min Kim Keun-Hwa Jung Seung-Hoon Lee Secondary prevention with antiplatelet medications in patients with antiphospholipid antibody-related stroke Scientific Reports Antiphospholipid syndrome Hemorrhage Ischemic stroke Secondary prevention Thrombosis |
| title | Secondary prevention with antiplatelet medications in patients with antiphospholipid antibody-related stroke |
| title_full | Secondary prevention with antiplatelet medications in patients with antiphospholipid antibody-related stroke |
| title_fullStr | Secondary prevention with antiplatelet medications in patients with antiphospholipid antibody-related stroke |
| title_full_unstemmed | Secondary prevention with antiplatelet medications in patients with antiphospholipid antibody-related stroke |
| title_short | Secondary prevention with antiplatelet medications in patients with antiphospholipid antibody-related stroke |
| title_sort | secondary prevention with antiplatelet medications in patients with antiphospholipid antibody related stroke |
| topic | Antiphospholipid syndrome Hemorrhage Ischemic stroke Secondary prevention Thrombosis |
| url | https://doi.org/10.1038/s41598-025-91739-w |
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