Direct oral anticoagulant use in patients with antiphospholipid syndrome and unprovoked venous thromboembolism: a single centre experience

Doyle, Andrew J.; Hunt, Beverley J.; Danaee, Anicee; Ling, Gavin; Desborough, Michael; Luo, Pu-Lin; Breen, Karen

doi:10.1111/bjh.17634

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…This recurrent thrombosis rate seemed to be close to those found in the literature. Doyle et al retrospectively analyzed 82 TAPS patients with primary VTE event treated with DOACs and found 4 (5%) recurrent thrombosis (2 arterial events and 2 VTE) with a median follow-up of 9 years 19 . Liu et al retrospectively compared 143 TAPS patients with prior arterial or VTE event and with single APL positivity treated with VKA or DOACs and found no difference in the recurrence rate (6/91 (6.5%) patients in the VKA group and 3/52 (6%) patients in the DOACs group) with a median follow-up of 4.6 years 20 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for recurrent thrombosis and comparison of DOACs vs VKA in selected thrombotic antiphospholipid syndrome

Guillaume,

Nicolas

et al. 2024

Preprint

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Introduction : Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of autoantibodies (anti-cardiolipin, anti-β2GP1, and lupus anticoagulant) associated with arterial, venous, or microcirculatory thrombotic events and/or obstetrical events (miscarriages, fetal death, and preterm deliveries). The treatment of thrombotic events is based on long-term anticoagulant therapy with vitamin K antagonist (VKA). Direct oral anticoagulants (DOACs) are not recommended by international guidelines as first-line therapy because of an increased risk of recurrent thrombosis observed in several randomized trials. This study aimed to report a cohort of patients with thrombotic antiphospholipid syndrome (TAPS) to identify risk factors associated with recurrent thrombosis and to identify differences between patients treated with VKA and patients treated with DOACs. Materials and methods : We collected data from 207 patients with TAPS from an initial population of 655 patients identified by automated screening software. Results : This retrospective longitudinal analysis based on real-life data confirmed previously identified risk factors for thrombotic recurrence, such as the absence of antithrombotic treatment following the initial thrombotic event, treatment with antiplatelet treatment alone following the initial thrombotic event. No difference between patients treated with VKA (n=123) or DOACs (n=50) were observed on the risk of recurrent thrombosis. Patients with VKA versus DOACs had more frequently triple APL positivity, presence of lupus anticoagulant and absence of an initial venous thrombotic event. Conclusions : This results suggest a potential use of DOACs in the treatment of TAPS for patients with a primary VTE event and a single APL positivity profile, although its retrospective design prevents firm recommendations.

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Section: Discussionmentioning

confidence: 99%

Risk factors for recurrent thrombosis and comparison of DOACs vs VKA in selected thrombotic antiphospholipid syndrome

Guillaume,

Nicolas

et al. 2024

Preprint

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“…There were 2 ATE (both ischemic strokes) and 2 VTE and no major bleeding events [17]. Doyle et al retrospectively reviewed the use of DOACs in 82 TAPS patients with unprovoked VTE, including 27% with triple positivity, none with previous ATE [18]. The incidence of recurrent thrombosis was higher in the triple positive group (1.7 events per 100 patient years) compared to the non-triple positive group (0.7 events per 100 patient years) [18].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of the direct oral anticoagulants in non-triple positive antiphospholipid syndrome without prior arterial thromboembolism

Kwan

Kaplovitch

Selby

et al. 2021

J Thromb Thrombolysis

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Thrombotic antiphospholipid syndrome (TAPS) is an autoimmune disorder that manifests with venous thromboembolism (VTE) and/or arterial thromboembolism (ATE) in the presence of persistent antiphospholipid antibodies (aPLs). Recent trials have failed to demonstrate non-inferiority of the direct oral anticoagulants (DOACs) compared to vitamin K antagonists as anticoagulation in TAPS, but there is a subgroup of non-triple positive patients without prior ATE in who only limited data exists. The objective of this study was to assess the effectiveness and safety of DOACs in non-triple positive TAPS without prior ATE. We conducted a retrospective review of all non-triple positive TAPS patients without prior ATE who were anticoagulated with a DOAC at two tertiary care hospitals from January 2010 to July 2020. We assessed outcomes of VTE, ATE, major bleeding, and clinically relevant non-major bleeding (CRNMB). 50 patients were included in the analysis, encompassing 157.2 years of patient follow-up. There were no recurrent VTE, but one patient had a possible arterial thrombosis (0.64 events per 100 patient-years [95% confidence interval (CI 0.16-35.49)] as a transient ischemic attack (TIA) which occurred on reduced dose DOAC. There were no major bleeding events, but two patients had CRNMB (1.27 events per 100 patient-years [95% CI 1.5-46.0]), both as menorrhagia. DOACs were effective and safe as anticoagulation in nontriple positive TAPS patients without prior ATE with a low rate of recurrent thrombosis and bleeding. Larger, prospective controlled studies are required to confirm these findings prior to routine use of DOACs in this subgroup. Keywords Antiphospholipid antibody syndrome (APLA) • Anticoagulation • Venous thromboembolism (VTE) • Antithrombotic therapy Highlights• Minimal data exists for the use of DOACs in non-triple positive TAPS without prior ATE.• DOACs had a low rate of thrombosis and no major bleeding in this demographic. • Further studies are required before DOACs are routinely used in this demographic..

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“…A recent report from a single center 17 included a cohort of 82 APS patients under DOAC therapy (27% of them with triple positivity) who were treated for a median time of 5 years. Recurrent thrombotic events were reported in 4 of 82 patients (5%).…”

Section: Secondary Thrombosis Prophylaxis In Patients With Aps—new Do...mentioning

confidence: 99%

Controversies in the Management of Antiphospholipid Syndrome

Porta

Andrade

Erkan³

et al. 2023

J Clin Rheumatol

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Strategies to prevent thrombosis in antiphospholipid antibody (aPL)–positive patients are of the utmost importance. The risk of thrombosis in patients with aPLs varies, depending on additional venous thrombosis and cardiovascular risk factors, as well as associated comorbidities. Recurrent thrombosis despite treatment with vitamin K antagonists is relatively common in daily practice. In this context, the effectiveness of the new direct oral anticoagulants in antiphospholipid syndrome is debated, as well as that of low-dose aspirin for primary thromboprophylaxis. There is an urgent unmet need to recognize the subgroup of patients that may benefit from low-dose aspirin use. Here we also discuss different points of view on primary and secondary thrombosis preventions in aPL-positive patients, which were presented as a debate during the 2021 PANLAR Congress (Pan-American League of the Association of Rheumatology) and that was organized by GESAF (Argentine Society of Rheumatology APS Study Group). It is the intention of this article to provide a useful discussion to aid treatment decision-making in daily clinical practice.

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Direct oral anticoagulant use in patients with antiphospholipid syndrome and unprovoked venous thromboembolism: a single centre experience

Cited by 6 publications

References 10 publications

Risk factors for recurrent thrombosis and comparison of DOACs vs VKA in selected thrombotic antiphospholipid syndrome

Risk factors for recurrent thrombosis and comparison of DOACs vs VKA in selected thrombotic antiphospholipid syndrome

Effectiveness and safety of the direct oral anticoagulants in non-triple positive antiphospholipid syndrome without prior arterial thromboembolism

Controversies in the Management of Antiphospholipid Syndrome

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