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Use of direct oral anticoagulants in antiphospholipid syndrome
Author(s) -
Cohen H.,
Efthymiou M.,
Isenberg D. A.
Publication year - 2018
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.14017
Subject(s) - rivaroxaban , medicine , antiphospholipid syndrome , warfarin , intensive care medicine , randomized controlled trial , clinical trial , apixaban , edoxaban , surrogate endpoint , anticoagulant , thrombosis , atrial fibrillation
Summary The direct oral anticoagulants ( DOAC s) are therapeutic alternatives to warfarin and other vitamin K antagonists ( VKA s), and constitute the standard of care for many indications. VKA s constitute the conventional therapy for the treatment and secondary thromboprophylaxis of thrombotic antiphospholipid syndrome ( APS ), but are often problematic, owing to the variable sensitivity of thromboplastins to lupus anticoagulant. Thus, the International Normalized Ratio may not accurately reflect anticoagulation intensity, or be clinically effective. Definition of the current role of DOAC s in the treatment of APS is based on limited clinical trial data and information from other sources, including manufacturers’ data, case series or cohort studies, and expert consensus. The Rivaroxaban in Antiphospholipid Syndrome ( RAPS ) randomized controlled trial ( RCT ), which had a laboratory surrogate primary outcome measure, suggests that rivaroxaban has the potential to be an effective and convenient alternative to warfarin in thrombotic APS patients with a single venous thromboembolism event requiring standard‐intensity anticoagulation. However, further studies, in particular to provide better long‐term efficacy and safety data, are needed before it can be widely recommended. APS patients are clinically heterogeneous, with the risk of recurrent thrombosis and the intensity of anticoagulation being influenced by their clinical phenotype and risk profile. DOAC trials involving homogeneous thrombotic APS populations, with the antiphospholipid antibody status well defined, will help to optimize the appropriate treatment in APS patient subgroups. Ongoing and emerging DOAC RCT s should provide further information to guide the use of DOAC s in APS patients. Optimal identification of APS patients is a key step in working towards improved therapeutic strategies in these individuals.