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Anti-thrombotics and major adverse cardiovascular events in anti-phospholipid syndrome: a cross-sectional study using
R Grovu1, A Nguyen2, K Sangaraju1
1Internal Medicine Department, Staten Island University Hospital, New York, NY, USA.
Insights
Anticoagulant therapy significantly reduces major adverse cardiovascular events (MACE) in patients with antiphospholipid syndrome (APS). Anti-platelets alone or combined with anticoagulants do not appear to benefit MACE reduction and may increase risk.
Area of Science:
- Cardiology
- Hematology
- Clinical Pharmacology
Background:
- Antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis.
- The optimal anti-thrombotic strategy for patients with APS remains a subject of ongoing research.
- Understanding the comparative effectiveness of different anti-thrombotic agents is crucial for patient management.
Purpose of the Study:
- To evaluate the association between different anti-thrombotic regimens and the occurrence of major adverse cardiovascular events (MACE) in patients diagnosed with APS.
- To determine if anti-coagulant and anti-platelet therapies offer a protective effect against MACE and mortality in APS patients.
Main Methods:
- A retrospective cohort study utilizing the National (Nationwide) Inpatient Sample (NIS) database from 2016-2018.
- Inclusion of 13,947 patients with APS, with data on demographics and covariates extracted using ICD-10 codes.
- Multivariate logistic regression analysis was employed to assess the impact of anti-thrombotic therapies on MACE and death.
Main Results:
- Anticoagulant therapy was associated with significantly reduced odds of MACE (OR 0.68) and death (OR 0.64).
- Patients not receiving anticoagulants had significantly increased odds of MACE (OR 1.47).
- Anti-platelet therapy, alone or in combination, showed no significant association with reduced MACE risk.
Conclusions:
- Anticoagulant therapy is the most effective anti-thrombotic strategy for reducing MACE in patients with APS.
- The use of anti-platelets, whether alone or with anticoagulants, does not appear to provide a benefit for MACE reduction and may potentially increase risk.
- Further research may be warranted to explore specific anti-thrombotic combinations in high-risk APS subgroups.
Objective:
This study assessed the relationship between anti-thrombotics and major adverse cardiovascular events (MACE) in patients with anti-phospholipid syndrome (APS).
Method:
We included 13 947 subjects with APS from the National (Nationwide) Inpatient Sample (NIS) database for 2016-2018, and collected relevant covariates and demographic data using ICD-10 codes. Our two primary outcomes were MACE and death. We performed multivariate logistic regression analysis to assess the impact of various anti-thrombotic regimens on MACE/death in our primary cohort and high-risk subgroups.
Results:
Patients on anti-coagulants had significantly reduced odds of MACE [odds ratio (OR) 0.68, 95% confidence interval (CI) 0.62-0.76, p < 0.001] as well as each of its subcomponents. Those not on any anti-coagulants had significantly increased odds of MACE (OR 1.47, 95% CI 1.24-1.72, p < 0.001). No significant association was found between anti-platelet use and the odds of MACE (p > 0.05). Patients on anti-coagulants were the only class that appeared to have a mortality benefit with reduced odds for death (OR 0.64, 95% CI 0.49-0.84, p = 0.001). In the subgroups at higher risk for MACE (those with atrial fibrillation and thrombocytopenia), full anti-coagulation therapy was also the only anti-thrombotic class that significantly affected the odds of MACE, with a protective effect on MACE, but had no mortality benefit.
Conclusion:
Patients with APS are most likely to benefit from anti-coagulant therapy in reducing MACE. Furthermore, anti-platelets alone or in combination with anti-coagulants are probably not beneficial in MACE reduction and may even increase risk.
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