Primary thromboprophylaxis with low-dose aspirin and antiphospholipid antibodies: Pro's and Con's Laurent Arnaud a, ⁎, Fabrizio Conti b , François Chasset d , Laura Massaro b , Gentian Denas c , Francois Chasset a , Vittorio Pengo c a Service de rhumatologie, Centre National de Référence des Maladies Autoimmunes et Systémiques Rares, Université de Strasbourg, INSERM UMR-S 1109, F-67000 Strasbourg, France b Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy c Department of Cardiac Thoracic and Vascular Sciences, Clinical Cardiology, Thrombosis Centre, University of Padova, Padova, Italy d Université Pierre et Marie Curie-Paris VI, Assistance Publique-Hôpitaux de Paris, Service de Dermatologie-Allergologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France abstract article info Article history: Received 14 July 2017 Accepted 19 July 2017 Available online xxxx Whether primary prophylaxis should be prescribed in individuals with antiphospholipid antibodies (aPL) re- mains controversial due to the lack of relevant evidence-based data. Indeed, it is unclear whether the benefit of LDA outweighs the risk of major bleeding associated LDA in a low-risk population. On the contrary, stratifica- tion of aPL-positive subjects according to their aPL profile (combination, isotype and titer), presence of other con- comitant risk factors for thrombosis and coexistence of an underling autoimmune disease is essential to decide whether primary prophylactic therapy should be prescribed. Additionally, the management of modifiable throm- botic risk factors is a necessary strategy, and the use of transient prophylaxis is crucial during high-risk periods. Specifically designed prospective trials are urgently needed to determine the real prophylactic impact of aspirin, as well as of alternative or concomitant therapeutic strategies such as hydroxychloroquine, statins or DOACS in aPL positive patients. © 2017 Published by Elsevier B.V. Keywords: Primary prophylaxis Antiphospholipid antibodies Aspirin Thrombosis Systematic review Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2. PRO'S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.1. Data from observational studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.2. Current recommendations for thromboprophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 2.3. Transient prophylaxis during high risk periods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3. CON'S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.1. Data from randomized controls trials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.2. Why is it necessary to stratify the risk of thrombosis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.3. The role of aPL-related factors (type, combinations, isotype, and titers of aPL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.3.1. Criteria aPL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.3.2. Anti-β2-glycoprotein I Domain I and non-criteria aPL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.4. The role of non aPL-related factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.4.1. Asymptomatic carriers versus patients with autoimmune disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.4.2. Additional thrombophilia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.4.3. Additional cardiovascular risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 3.5. Scoring models for thrombosis risk assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 4. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Take-home messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Autoimmunity Reviews xxx (2017) xxx–xxx ⁎ Corresponding author at: Department of rheumatology, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France. E-mail address: Laurent.arnaud@chru-strasbourg.fr (L. Arnaud). AUTREV-02058; No of Pages 6 http://dx.doi.org/10.1016/j.autrev.2017.09.003 1568-9972/© 2017 Published by Elsevier B.V. Contents lists available at ScienceDirect Autoimmunity Reviews journal homepage: www.elsevier.com/locate/autrev Please cite this article as: Arnaud L, et al, Primary thromboprophylaxis with low-dose aspirin and antiphospholipid antibodies: Pro's and Con's, Autoimmun Rev (2017), http://dx.doi.org/10.1016/j.autrev.2017.09.003