Safety and efficacy of oral direct inhibitors of thrombin and factor Xa in antiphospholipid syndrome

Noël, Nicolas; Dutasta, F.; Costédoat-Chalumeau, Nathalie; Bienvenu, Boris; Mariette, Xavier; Geffray, L.; Sène, Damien; Chaidi, Rafik Bekhadj; Michot, Jean‐Marie; Fain, Olivier; Darnige, Luc; Ankri, Annick; Cacoub, Patrice; Piette, Jean‐Charles; Saadoun, David

doi:10.1016/j.autrev.2015.03.007

Cited by 63 publications

(41 citation statements)

References 22 publications

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“…In a series 16 of 35 patients with APS and history of venous thrombosis with indication for moderate intensity anticoagulation (INR 2 to 3), but in whom there were difficulties achieving or maintaining the therapeutic target, VKA were substituted with 20 mg rivaroxaban per day, after which no new venous thromboembolism events were observed during follow-up with a median duration of 10 (6-24) months. Another publication 38 describes treatment of 26 patients with APS and history of venous and/or arterial thrombosis with dabigatran or rivaroxaban. After median follow-up of 19 (8-29) months, treatment was discontinued in just four cases (recurrent thrombosis in one patient, hemorrhagic complications in two patients, and recurrent migraines in one patient).…”

Section: -34mentioning

confidence: 99%

A importância de reconhecer a síndrome antifosfolípide na medicina vascular

et al. 2017

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Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by recurrent arterial or venous thrombosis and/or gestational morbidity and by the presence of antiphospholipid antibodies. It can also cause other vascular manifestations such as microangiopathy, chronic arteriopathy and catastrophic APS (CAPS). Certain laboratory tests for the syndrome (for example, the lupus anticoagulant test) can be affected by the use of anticoagulant agents, making diagnosis more difficult. The pathophysiology of APS is complex, and several mechanisms of pathogenesis related to coagulation, endothelium, and platelets are discussed in this article. We conclude by discussing treatment of APS according to the presence and type of clinical manifestations, use of direct oral anticoagulants (DOAs), and perioperative management of patients with APS.Keywords: antiphospholipid syndrome; lupus anticoagulant; anticardiolipin antibodies; thrombosis; autoimmunity. ResumoA síndrome antifosfolipíde (SAF) é uma doença autoimune sistêmica caracterizada por trombose arterial ou venosa recorrente e/ou morbidade gestacional e pela presença dos anticorpos antifosfolipídeos, podendo apresentar outras manifestações vasculares, como microangiopatia, arteriopatia crônica e SAF catastrófica. Determinados testes laboratoriais para a síndrome (por exemplo, o anticoagulante lúpico) podem sofrer interferência do uso de medicações anticoagulantes, dificultando o diagnóstico. A fisiopatologia da SAF é complexa, sendo enumerados no texto diversos mecanismos patogênicos relacionados à coagulação, ao endotélio e às plaquetas. Por fim, discutimos o tratamento da SAF de acordo com a presença e o tipo de manifestações clínicas, o uso dos anticoagulantes orais diretos e o manejo perioperatório de pacientes com SAF.Palavras-chave: síndrome antifosfolípide; anticoagulante do lúpus; anticorpos anticardiolipina; trombose; autoimunidade.

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Section: -34mentioning

confidence: 99%

A importância de reconhecer a síndrome antifosfolípide na medicina vascular

et al. 2017

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“…Signorelli et al [42] have presented 8 patients with APS treated with rivaroxaban who experienced thrombosis recurrence, including 5 patients with triple positivity and 2 subjects with previous arterial thrombosis. On the other hand, several reports indicated good efficacy of DOACs in APS even with no or only one thrombotic relapse during follow-up [43,44].…”

Section: Antiphospholipid Syndromementioning

confidence: 99%

Direct Oral Anticoagulants in Patients with Thrombophilia: Challenges in Diagnostic Evaluation and Treatment

Undas

Góralczyk

2016

Adv Clin Exp Med

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“…Three patients withdrew from the rivaroxaban group due to adverse events (n = 2, bleeding events; n = 1, recurrent migraines). 28 …”

Section: Observational Cohort Studymentioning

confidence: 99%

Role of Novel Oral Anticoagulants in the Treatment of Antiphospholipid Syndrome

2016

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Background Antiphospholipid syndrome (APS) is an autoimmune disease characterized by thrombosis or pregnancy loss with persistent positive antibodies. Standard treatment for APS with history of thromboembolism is heparin or low-molecular-weight heparin followed by a vitamin K antagonist (VKA). Novel oral anticoagulants (NOACs) could be effective in patients with APS, but none carry indications for treatment related to APS. Clinical Evidence Five case reports or series with rivaroxaban and dabigatran suggest thrombotic events occur most often in the higher risk population (arterial thrombosis and/or triple positive antibodies) or in patients who had recurrent VTEs on warfarin therapy. An observational cohort in 26 APS patients using dabigatran or rivaroxaban described a recurrent thrombotic event in only 1 patient after 8 months of treatment. The event-free survival rate was 87.9% at 12 months. Three controlled clinical trials are underway to evaluate the thrombotic risk of NOACs (RAPS, TRAPS, and ASTRO-APS). Discussion There are no completed studies that evaluate the use of NOACs in APS compared to VKAs. One major disadvantage of the NOACs is the limited availability of reversal agents for patients with a major bleeding episode. An increased risk of thrombotic events is associated with arterial occlusions and triple antibody positivity APS with both warfarin and NOACs; this is currently being researched in the TRAPS study. Conclusion Based on current available evidence, VKAs remain the standard of care in the treatment of APS. Results of ongoing trials may offer more guidance on how to appropriately use NOACs for patients with APS.

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Safety and efficacy of oral direct inhibitors of thrombin and factor Xa in antiphospholipid syndrome

Cited by 63 publications

References 22 publications

A importância de reconhecer a síndrome antifosfolípide na medicina vascular

A importância de reconhecer a síndrome antifosfolípide na medicina vascular

Direct Oral Anticoagulants in Patients with Thrombophilia: Challenges in Diagnostic Evaluation and Treatment

Role of Novel Oral Anticoagulants in the Treatment of Antiphospholipid Syndrome

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