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Direct oral anticoagulants versus warfarin in patients with single or double antibody-positive antiphospholipid syndrome

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Abstract

Warfarin is recognized as the standard treatment for thrombotic antiphospholipid syndrome (APS); however, direct oral anticoagulants (DOACs) represent appealing therapeutic alternatives given their lack of monitoring and limited drug interactions. A few randomized controlled trials comparing rivaroxaban with warfarin showed an increased risk of recurrent thromboembolism, specifically arterial thrombosis, in patients with high risk forms of APS such as those that are triple antibody positive. We conducted a single-center, retrospective cohort study of all patients within our health system from 2015 to 2020 with a diagnosis of APS (single or double antibody positive) and history of venous thromboembolism. We sought to compare the proportion of patients with a recurrent thrombosis when prescribed a DOAC versus warfarin. Among 96 patients included, 57 were prescribed warfarin and 39 were prescribed a DOAC (90% rivaroxaban). The proportion of patients with a recurrent thromboembolism was almost three times higher in the DOAC group (15.4%) compared to the warfarin group (5.3%), although this was not statistically significant (p = 0.15). Major bleeding was not different between groups. Our findings suggest that rivaroxaban may pose an increased risk for recurrent thromboembolism in low risk APS patients that are single or double-antibody positive compared to warfarin. Results of our study should be cautiously applied to DOACs besides rivaroxaban given their small representation in this study.

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Authors and Affiliations

  1. Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 80045, USA

    Briana Williams, Joseph J. Saseen, Toby Trujillo & Surabhi Palkimas

  2. Department of Clinical Pharmacy, University of Colorado Hospital, Aurora, CO, 80045, USA

    Toby Trujillo

  3. Division of Hematology, Department of Ambulatory Clinical Pharmacy, University of Colorado Hospital, Aurora, CO, 80045, USA

    Surabhi Palkimas

Authors
  1. Briana Williams
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  2. Joseph J. Saseen
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  3. Toby Trujillo
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  4. Surabhi Palkimas
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All authors contributed to the development of the study proposal. BW collected all data and wrote the initial manuscript draft. All authors revised the manuscript and approved the final manuscript.

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Correspondence to Surabhi Palkimas.

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Williams, B., Saseen, J.J., Trujillo, T. et al. Direct oral anticoagulants versus warfarin in patients with single or double antibody-positive antiphospholipid syndrome. J Thromb Thrombolysis 54, 67–73 (2022). https://doi.org/10.1007/s11239-021-02587-0

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  • DOI: https://doi.org/10.1007/s11239-021-02587-0

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