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Direct Oral Anticoagulants Use in Antiphospholipid Syndrome: Are These Drugs an Effective and Safe Alternative to Warfarin? A Systematic Review of the Literature

  • Antiphospholipid Syndrome (S Zuily, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

A Letters to the Editor to this article was published on 20 July 2017

Abstract

Background

The cornerstone of thrombotic antiphospholipid syndrome (APS) patients’ management is to prevent recurrent thrombosis by long-term anticoagulation.

Purpose of review

The purpose of the review is to summarize available literature on direct oral anticoagulants (DOACs) use in APS patients through a systematic review and to determine factors associated with thrombosis recurrence.

Recent findings

The recent RAPS trial demonstrated that APS patients treated with rivaroxaban had a significant twofold-increased thrombin potential, suggesting a higher thrombotic risk, in comparison with warfarin users. Furthermore, several reports of APS patients treated with DOACs have raised safety issues. Our systematic review identified 122 published APS patients treated with DOACs; among them, 19 experienced a recurrent thrombosis while on DOACs. Of note, triple positivity (positivity of all three laboratory criteria for APS) was associated with a 3.5-fold increased risk for recurrent thrombosis.

Summary

In conclusion, DOACs should be used with caution in APS patients and randomized control trials with clinical primary endpoints assessing clinical efficacy and safety are awaited to establish whether the prescription of DOACs could be a safe alternative to warfarin.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. CHRU de Nancy, Vascular Medicine Division and Regional Competence Center For Rare Vascular And Systemic Autoimmune Diseases, Nancy, France

    Virginie Dufrost, Jessie Risse, Stéphane Zuily & Denis Wahl

  2. Inserm UMR_S 1116 at Lorraine University, Nancy, France

    Jessie Risse, Stéphane Zuily & Denis Wahl

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  1. Virginie Dufrost
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  2. Jessie Risse
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  3. Stéphane Zuily
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  4. Denis Wahl
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Correspondence to Stéphane Zuily.

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This article is part of the Topical Collection on Antiphospholipid Syndrome

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Dufrost, V., Risse, J., Zuily, S. et al. Direct Oral Anticoagulants Use in Antiphospholipid Syndrome: Are These Drugs an Effective and Safe Alternative to Warfarin? A Systematic Review of the Literature. Curr Rheumatol Rep 18, 74 (2016). https://doi.org/10.1007/s11926-016-0623-7

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