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Use of New Oral Anticoagulants in Antiphospholipid Syndrome

  • ANTIPHOSPHOLIPID SYNDROME (RAS ROUBEY, SECTION EDITOR)
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Abstract

The current mainstay of treatment of thrombotic APS is long-term anticoagulation with oral vitamin K antagonists (VKA) such as warfarin. However, the use of warfarin is problematic, particularly in patients with antiphospholipid syndrome (APS). The new oral anticoagulants (NOAC) include dabigatran etexilate (Pradaxa®), a direct thrombin inhibitor, and rivaroxaban (Xarelto®), Apixaban (Eliquis) and Edoxaban (Lixiana®), which are direct anti-Xa inhibitors. Unlike warfarin, these agents do not interact with dietary constituents and alcohol, have few reported drug interactions, and monitoring of their anticoagulant intensity is not routinely required due to their predictable anticoagulant effects. In this chapter, we discuss clinical and laboratory aspects of NOAC. These agents have been approved for several therapeutic indications based on phase III prospective randomised controlled clinical trials using warfarin at a target INR of 2.5 (i.e. range 2.0–3.0) as the comparator. However these trials may not be directly applicable to patients with antiphospholipid syndrome (APS) where prospective clinical studies of NOAC are the way forward.

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Conflict of Interest

Deepa Jayakody Arachchillage has received support for travel and accommodation to attend scientific meetings from Boehringer Ingelheim.

Hannah Cohen has lectured at/chaired meetings and participated in an Advisory Board for Bayer HealthCare but received no personal payment; and had accommodation provided by Boehringer Ingelheim at scientific meetings. University College London received an unrestricted educational grant and funding for specific pharmacovigilance functions in the RAPS trial from Bayer; and rivroxaban is being provided without charge for this trial.

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  1. Haemostasis Research Unit, Department of Haematology, University College London and University College London Hospitals NHS Foundation Trust, 1st Floor, 51 Chenies Mews, London, WC1E 6HX, UK

    Deepa Jayakody Arachchillage

  2. University College London Hospitals NHS Foundation Trust and University College London, 1st Floor Central 250 Euston Road, London, NW1 2PJ, UK

    Hannah Cohen

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  1. Deepa Jayakody Arachchillage
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Correspondence to Hannah Cohen.

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This article is part of the Topical Collection on Antiphospholipid Syndrome

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Arachchillage, D.J., Cohen, H. Use of New Oral Anticoagulants in Antiphospholipid Syndrome. Curr Rheumatol Rep 15, 331 (2013). https://doi.org/10.1007/s11926-013-0331-5

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