There is a scarcity of high-quality randomized controlled trials (RCTs) comparing antithrombotic regimens for secondary prevention of arterial thrombosis (AT) in antiphospholipid syndrome (APS). We reviewed different antithrombotic regimens used for this purpose. We searched for studies on management of AT in APS on PubMed and Web of Science. Eleven studies (5 RCTs, 3 prospective, and 3 retrospective cohort studies) comparing different regimens and reporting outcomes specifically for patients with index AT events were identified. Treatments were vitamin K antagonists (VKA; 9 studies), non-VKA oral anticoagulant (NOAC; 3 studies), single antiplatelet therapy (SAPT; 7 studies), dual antiplatelet therapy (DAPT; 2 studies), and VKA combined with SAPT (4 studies). We performed a meta-analysis for the outcomes: recurrent AT, any (arterial or venous) recurrent thromboembolism, and major bleeding. Recurrent AT was reduced with VKA plus SAPT versus VKA (risk ratio [RR]: 0.43; 95% confidence interval [CI]: 0.22–0.85) and with DAPT versus SAPT (RR: 0.29; 95% CI: 0.09–0.99). Any recurrent thromboembolism was reduced with VKA plus SAPT versus VKA alone (RR: 0.41; 95% CI: 0.24–0.69) and versus SAPT alone (RR: 0.36; 95% CI: 0.13–0.96). There were no significant differences between other treatments for thromboembolism and for none of the comparisons regarding major bleeding. In a sensitivity analysis, excluding low-quality studies, VKA was more effective than NOAC to prevent recurrent AT (RR: 0.25; 95% CI: 0.07–0.93). Combined antithrombotic therapy might be more effective than single agents as secondary prophylaxis in APS with AT, and does not seem to compromise with safety, but the quality of evidence is generally low. NOACs should be avoided for patients with APS and AT.

很少有高质量的随机对照试验 (RCT) 比较抗血栓治疗方案用于抗磷脂综合征 (APS) 中动脉血栓形成 (AT) 的二级预防。我们回顾了用于此目的的不同抗血栓治疗方案。我们在 PubMed 和 Web of Science 上搜索了关于 APS 中 AT 管理的研究。确定了 11 项研究（5 项 RCT、3 项前瞻性和 3 项回顾性队列研究）比较了不同方案并专门针对有指数 AT 事件的患者报告了结果。治疗包括维生素 K 拮抗剂（VKA；9 项研究）、非 VKA 口服抗凝剂（NOAC；3 项研究）、单一抗血小板治疗（SAPT；7 项研究）、双重抗血小板治疗（DAPT；2 项研究）和 VKA 联合 SAPT（ 4 项研究）。我们对结果进行了荟萃分析：复发性 AT，任何（动脉或静脉）复发性血栓栓塞和大出血。VKA 加 SAPT 与 VKA（风险比 [RR]：0.43；95% 置信区间 [CI]：0.22-0.85）和 DAPT 与 SAPT（RR：0.29；95% CI：0.09-0.99）相比，复发性 AT 减少。与单独使用 VKA（RR：0.41；95% CI：0.24-0.69）和单独使用 SAPT（RR：0.36；95% CI：0.13-0.96）相比，VKA 加 SAPT 可减少任何复发性血栓栓塞。血栓栓塞的其他治疗方法之间没有显着差异，并且没有一项关于大出血的比较。在排除低质量研究的敏感性分析中，VKA 在预防 AT 复发方面比 NOAC 更有效（RR：0.25；95% CI：0.07-0.93）。联合抗血栓治疗作为 APS 合并 AT 的二级预防可能比单一药物更有效，并且似乎不会影响安全性，但证据质量普遍较低。APS 和 AT 患者应避免使用 NOAC。