Direct oral anticoagulants in antiphospholipid syndrome: a real life case series

Lupus. 2016 May;25(6):658-62. doi: 10.1177/0961203315624555. Epub 2016 Jan 6.

Abstract

Aim: The aim of this study was to describe a case series of patients with primary or secondary antiphospholipid syndrome (APS) treated with direct oral anticoagulants (DOACs).

Patients and methods: Clinical charts of eight patients with thrombotic primary or secondary APS treated with direct oral anticoagulants (DOACs) between January 2012 and May 2015 were reviewed.

Results: The mean age was 45 ± 14.36 (range 27-69 years). Four patients had secondary APS (50%). All patients were initially treated with warfarin by a mean time of 70.87 ± 57.32 months (range 17-153 months). Changes in anticoagulation were defined by recurring thrombosis in five patients (62.5%) and life-threatening bleeding in the other three cases. Seven patients (87.5%) received rivaroxaban treatment and one patient (12.5%) apixaban. The mean follow-up period with DOACs was 19 ± 10.06 months (range 2-36 months). There was no recurrence of thrombosis by the time of data collection.

Conclusions: Despite not being the standard treatment in APS, we propose DOACs as a rational alternative for the management of patients with this diagnosis. Further interventional clinical studies are necessary for possible standardization of this therapy in APS patients.

Keywords: Antiphospholipid syndrome; anticoagulation; direct oral anticoagulants; thrombosis.

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use*
  • Antiphospholipid Syndrome / complications
  • Antiphospholipid Syndrome / drug therapy*
  • Female
  • Follow-Up Studies
  • Hemorrhage / chemically induced*
  • Hemorrhage / epidemiology
  • Humans
  • Middle Aged
  • Pyrazoles / adverse effects
  • Pyrazoles / therapeutic use
  • Pyridones / adverse effects
  • Pyridones / therapeutic use
  • Recurrence
  • Retrospective Studies
  • Rivaroxaban / adverse effects
  • Rivaroxaban / therapeutic use
  • Thrombosis / etiology
  • Thrombosis / prevention & control*
  • Treatment Outcome
  • Warfarin / adverse effects
  • Warfarin / therapeutic use

Substances

  • Anticoagulants
  • Pyrazoles
  • Pyridones
  • apixaban
  • Warfarin
  • Rivaroxaban