This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (38)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Thrombolysis  • Dermatology  • Connective Tissue Diseases  • Cardiovascular System  • Rheumatology, Other  • Immunologic Disorders  • Alert me on articles by topic  Social Bookmarking   What's this?

Do the Benefits Outweigh the Risks? A Decision Analysis

Denis G. Wahl, MD, PhD; Henri Bounameaux, MD; Philippe de Moerloose, MD; François P. Sarasin, MD

Arch Intern Med. 2000;160:2042-2048.

Background  A high incidence of both arterial and venous thromboembolic events has been reported in patients with systemic lupus erythematosus (SLE), but the risks and benefits of primary prophylactic antithrombotic therapy have not been assessed. We measured the clinical benefit of 3 antithrombotic regimens in patients with SLE without antiphospholipid antibodies, with anticardiolipin antibodies, or with lupus anticoagulant.

Methods  A Markov decision analysis was used to evaluate prophylactic aspirin therapy, prophylactic oral anticoagulant therapy, and observation. Input data were obtained by literature review. Clinical practice was simulated in a hypothetical cohort of patients with SLE who had not experienced any previous episode of arterial or venous thromboembolic events. For each strategy, we measured numbers of thromboembolic events prevented and major bleeding episodes induced, and quality-adjusted survival years.

Results  Prophylactic aspirin therapy was the preferred strategy in all settings, the number of prevented thrombotic events exceeding that of induced bleeding episodes. In the baseline analysis (40-year-old patients with SLE), the gain in quality-adjusted survival years achieved by prophylactic aspirin compared with observation ranged from 3 months in patients without antiphospholipid antibodies to 11 months in patients with anticardiolipin antibodies or lupus anticoagulant. Prophylactic oral anticoagulant therapy provided better results than prophylactic aspirin only in patients with lupus anticoagulant and an estimated bleeding risk of 1% per year or less.

Conclusions  Prophylactic aspirin should be given to all patients with SLE to prevent both arterial and venous thrombotic manifestations, especially in patients with antiphospholipid antibodies. In selected patients with lupus anticoagulant and a low bleeding risk, prophylactic oral anticoagulant therapy may provide a higher utility.

From the Division of Angiology and Hemostasis (Drs Wahl, Bounameaux, and de Moerloose), and Clinique de Médecine 1 (Dr Sarasin), Department of Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland. Dr Wahl is now with the Service de Médecine Interne H, Centre Hospitalier Universitaire, Nancy, and Faculté de Médecine, Vandoeuvre-Les-Nancy, France.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Risk factors for a first thrombotic event in antiphospholipid antibody carriers. A multicentre, retrospective follow-up study
Ruffatti et al.
Ann Rheum Dis 2009;68:397-399.
ABSTRACT | FULL TEXT  

The Activated Seven Lupus Anticoagulant Assay Detects Clinically Significant Antibodies
Moore et al.
CLIN APPL THROMB HEMOST 2008;14:332-337.
ABSTRACT  

Angiotensin-converting enzyme inhibitors delay the occurrence of renal involvement and are associated with a decreased risk of disease activity in patients with systemic lupus erythematosus--results from LUMINA (LIX): a multiethnic US cohort
Duran-Barragan et al.
Rheumatology (Oxford) 2008;47:1093-1096.
ABSTRACT | FULL TEXT  

Influence of aspirin on the clinical outcomes of 103 anti-phospholipid antibodies-positive patients
Hereng et al.
Lupus 2008;17:11-15.
ABSTRACT  

Lupus and cardiovascular disease: the facts
Szekanecz and Shoenfeld
Lupus 2006;15:3-10.
ABSTRACT  

Heart involvement in systemic lupus erythematosus, anti-phospholipid syndrome and neonatal lupus
Tincani et al.
Rheumatology (Oxford) 2006;45:iv8-iv13.
ABSTRACT | FULL TEXT  

Treatment of antiphospholipid antibody syndrome.
Wahl and Regnault
JAMA 2006;296:42-43.
FULL TEXT  

Antiphospholipid antibodies predict early damage in patients with systemic lupus erythematosus
Ruiz-Irastorza et al.
Lupus 2004;13:900-905.
ABSTRACT  

Antiphospholipid Testing and Outcome--Reply
Ruiz-Irastorza et al.
Arch Intern Med 2004;164:1701-1702.
FULL TEXT  

Current Debates in Antiphospholipid Syndrome: The Acquired Antibody-Mediated Thrombophilia
Ozturk et al.
CLIN APPL THROMB HEMOST 2004;10:89-126.
ABSTRACT  

High Impact of Antiphospholipid Syndrome on Irreversible Organ Damage and Survival of Patients With Systemic Lupus Erythematosus
Ruiz-Irastorza et al.
Arch Intern Med 2004;164:77-82.
ABSTRACT | FULL TEXT  

Prevention of cardiovascular disease in systemic lupus erythematosus--proposed guidelines for risk factor management
Wajed et al.
Rheumatology (Oxford) 2004;43:7-12.
FULL TEXT  

Prophylaxis of the antiphospholipid syndrome: a consensus report
Alarcon-Segovia et al.
Lupus 2003;12:499-503.
ABSTRACT  

A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome
Erkan et al.
Rheumatology (Oxford) 2002;41:924-929.
ABSTRACT | FULL TEXT  

The central nervous system in systemic lupus erythematosus. Part 2. Pathogenetic mechanisms of clinical syndromes: a literature investigation
Jennekens and Kater
Rheumatology (Oxford) 2002;41:619-630.
ABSTRACT | FULL TEXT  

Should low-dose aspirin also be a background therapy for all patients with systemic lupus erythematosus (SLE)?
Malaviya and Mourou
Lupus 2000;9:561-562.