Article Text

Download PDFPDF

03 Low dose aspirin in aPL-positive patients: Are we treating the patient or the doctor?
  1. Denis Wahl
  1. University of Lorraine, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, France


Patients with antiphospholipid antibodies (aPL) are at increased risk for arterial or venous thrombosis. There is, however, significant heterogeneity among patients according to clinical and laboratory features. Therefore, two therapeutic modalities can be discussed for primary prevention of thrombosis in patients: (1) primary prophylaxis in all aPL patients or (2) only in selected high-risk patients. Because aPL are often diagnosed in patients with systemic lupus erythematosus before occurrence of a first thrombosis, primary prophylaxis should be specifically discussed in this setting.

Risk for thrombosis in lupus patients may be increased by additional clinical risk factors, in particular hypertension. Laboratory profile is also important: lupus anticoagulant, double (any combination of lupus anticoagulant, anticardiolipin antibodies or anti-b2 glycoprotein I antibodies) or triple (all three subtypes) aPL positivity, as well as the presence of persistently high aPL titres indicate high risk patients. Specific risk scores may be helpful such as the global antiphospholipid syndrome score (GAPSS).

Observational data indicate that low dose aspirin reduces the risk of first thrombosis in aPL patients, particularly in those with lupus (by 50%) with a low bleeding risk. To improve the risk:benefit ratio, prescribe aspirin in patients with high-risk profiles and low bleeding risk.

Treatment failure may be due to aspirin resistance (insufficient dosage, poor absorption or drug interaction) or poor treatment adherence (long term prophylactic treatment in young patients) of which the attending physician must be aware.

In summary, prophylactic low dose aspirin in aPL positive lupus patients should be considered taking into account thrombotic and bleeding risks. Because of its long-term objectives, this treatment should be carefully explained and discussed with the patient before taking a shared decision.

Learning Objectives

  • Explain when primary prophylaxis should be used for APL

  • Describe the risk factors for thrombosis in patients with lupus

  • Discuss optimal treatment options for thrombosis risk reduction in patients with aPL

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.