Klin Farmakol Farm. 2021;35(4):101-105 | DOI: 10.36290/far.2021.024

Antithrombotic therapy in antiphospholipid syndrome, the role of direct oral anticoagulants

Jana Hirmerová

II. interní klinika, LF UK a FN Plzeň

Antiphospholipid syndrome (APS) is an autoimmune, acquired hypercoagulable disorder. It is characterized by a presence of antiphospholipid antibodies (APA) and heterogeneous clinical manifestations, dominated by thrombosis (venous, arterial or small vessel thrombosis) and/or pregnancy complications. Because of high risk of thrombosis recurrence, secondary antithrombotic prophylaxis is of critical importance. Anticoagulation represents the cornerstone of therapy, including the cases of arterial thrombosis. Warfarin remains the first-choice therapy, usually with target INR (international normalized ratio) 2-3. Direct oral anticoagulants (DOACs) are not recommended in APS, based on the recent data. Studies have revealed an increased risk of arterial thrombosis, especially in high-risk APS patients treated with rivaroxaban, compared to warfarin. DOACs may be considered in patients with venous thromboembolism and lower risk APS, in those not able to achieve a target INR despite good adherence, or in APS patients with warfarin allergy or intolerance. Ongoing studies will hopefully bring new data about efficacy and safety of DOACs in APS.

Keywords: antiphospholipid syndrome, thrombosis, anticoagulation, warfarin, direct oral anticoagulants.

Published: January 4, 2022  Show citation