Rivaroxaban Versus Vitamin K Antagonist in Antiphospholipid Syndrome

Ordi‐Ros, Josep; Sáez‐Comet, Luis; Pérez-Conesa, M.; Vidal, Xavier; Riera‐Mestre, Antoni; Castro‐Salomó, Antoni; Cuquet-Pedragosa, Jordi; Ortiz-Santamaría, Vera; Mauri-Plana, Montserrat; Solé, Cristina; Cortés-Hernández, Josefina

doi:10.7326/m19-0291

Cited by 236 publications

(208 citation statements)

References 34 publications

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“…1 Finally, in the randomized study published by Ordi-Ros et al, one of the patients treated with rivaroxaban developed a CAPS. 2 Conclusions These two cases, as well as two previous reported cases, underline the importance of avoiding DOACs in patients with APS, especially those triple positive for antiphospholipid antibodies. VKAs must remain the reference anticoagulation treatment in this setting.…”

Section: P7supporting

confidence: 63%

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P6 Rituximab efficacy in CAPS

Yakymenko

Vasylets

Клочко

et al. 2020

Poster Presentations

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Background Antiphospholipid Syndrome (APS) is a known cause of thrombotic disorders, including Acute Myocardial Infarction (AMI). Although its incidence in AMI patients is not known, it may be an important factor in precipitating infarction, especially in younger adults. Methods This is a case-control study consisting in 73 patients with Acute Myocardial Infarction, hospitalized at Cardiovascular Reanimation Clinic from 10 December 2015-10 October 2019. All patients included in the study were from 23 to 50 years old. In the case-group were included 24 patients with Antiphospholipid Syndrome and Acute Myocardial Infarction, and 49 patients were included in the control group, which consisted only in patients with AMI, with no presence of APS. In every patient were gathered data such as complete blood count + ESR, Antinuclear Antibodies (ANA), Anti-cardiolipin antibodies (ACA), C3 and C4 complement fraction, Anti-ds-DNA, CRP and Ejection Fraction (EF) in echocardiography. Female patients were asked about their abortion history. As recommended in the guidelines, in positive results for APS, ACA levels were repeated after 12 weeks in order to establish the diagnosis. All data were gathered and statistically analyzed using Excel 2010 and IBM SPSS. Results After comparing all gathered data, it was found that the patients with APS and AMI had a more significant tendency to have C3 hypocomplementemia (p=0.006), thrombocytopenia (p=0.002), a lower ejection fraction on transthoracic echocardiography (p=0.04) and a more elevated number of abortions before acute myocardial infarction (p=0.03) in comparison to the controls. Conclusions From our study it was found that APS is not rare in young adults with AMI. It should be always suspected in young patients with no cardiovascular risk factors and there may be a characteristic clinical and laboratory picture in patients with AMI, which may suggest the APS diagnosis. Acknowledgements The authors declare no conflict of interest.

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Section: P7supporting

confidence: 63%

“…Romain Stammler,1 Paul Legendre, 2 Patrice Cacoub, 1 Philippe Blanche,2 Jean Charles Piette, 1 Nathalie Costedoat-Chalumeau 1. Internal Medicine Dept., AP-HP Cochin Hospital, Paris; 2 Internal Medicine Dept., AP-HP La Pitié-Salpêtrière Hospital, Paris, France 10.1136/lupus-2020-eurolupus.56…”

mentioning

confidence: 99%

P6 Rituximab efficacy in CAPS

Yakymenko

Vasylets

Клочко

et al. 2020

Poster Presentations

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“…Moreover, the antibody profile of the patients in this study was not reported. In the intention to treat analysis of the RCT by Ordi‐Ros et al, no increased risk of venous events was found in patients treated with rivaroxaban versus VKA (hazard ratio [HR], 0.70 [confidence interval (CI), 0.12‐4.18]) 19 . Similarly a meta‐analysis of pivotal RCTs concluded that prevention of recurrent VTE with DOACs was as effective and safe as with VKAs 24 .…”

Section: What Do We Know?mentioning

confidence: 99%

Use of direct oral anticoagulants in patients with thrombotic antiphospholipid syndrome: Guidance from the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis

Zuily

Cohen

Isenberg

et al. 2020

Journal of Thrombosis and Haemostasis

110

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Clarity and guidance is required with regard to the use of direct oral anticoagulants in antiphospholipid syndrome (APS) patients, within the confines of the recent European Medicines Agency recommendations, discrepant recommendations in other international guidelines and the limited evidence base. To address this, the Lupus Anticoagulant/Antiphospholipid Antibodies Scientific and Standardization Committee (SSC) chair and co‐chairs together with SSC Control of Anticoagulation members propose guidance for healthcare professionals to help them manage APS patients. Uncertainty in this field will be addressed. This guidance will also serve as a call and focus for research.

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“…Three out of 7 arterial thrombotic events occurred in patients originally diagnosed with venous thromboembolism [4]. In the Spanish study, rivaroxaban did not show non-inferiority to dose adjusted VKA in thrombotic APS, with a thrombotic recurrence rate of 11.6% and 6.3% respectively [5]. This difference was mainly due to the occurrence of 9 stroke events with rivaroxaban and 0 event with VKAs.…”

Section: Pathophysiology Of Thrombosis Risk In Ct -Theoretical Interamentioning

confidence: 81%

“…The efficacy of DOACs may not be equivalent to VKAs in every disease state as recently pointed out by the results of the TRAPS study and the Spanish trial recently published from Ordi-Ros et al [4,5] These trials suggest that in the antiphospholipid antibody syndrome, rivaroxaban was associated with a higher risk of thromboembolic events compared to VKAs. In the TRAPS trial, the recurrent events were mostly arterial events.…”

Section: Pathophysiology Of Thrombosis Risk In Ct -Theoretical Interamentioning

confidence: 99%