2021
DOI: 10.7759/cureus.17106
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A Difficult and Rare Case of Warfarin Refractory Antiphospholipid Syndrome Presenting With Catastrophic Antiphospholipid Syndrome Complicated by Gastrointestinal Bleeding

Abstract: Antiphospholipid syndrome (APS) is managed with warfarin for secondary prophylaxis in patients who have had a thrombotic event in the past. Warfarin has been deemed superior to novel oral anticoagulants in preventing venous and arterial thrombosis in conjunction with aspirin. The catastrophic variant of APS (CAPS) is very rarely reported, especially in those who have been on a therapeutic dose of warfarin therapy. We present a rare case of CAPS in a patient with a history of APS who had been on a therapeutic d… Show more

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“…Regarding treating CAPS, the consensus is to employ anticoagulants and corticosteroids in all patients [8]. While there are no randomized-controlled trials (RCTs) on specific types of anticoagulants in CAPS specifically due to low prevalence, there have been several recent studies on APS in general showing that warfarin prevents anticoagulation more efficaciously than direct oral anticoagulants (DOACs) and that DOACs increase the risk of thromboses compared to warfarin [8,9,10]. Hence, the patient was switched from apixaban to warfarin upon the suspected diagnosis of CAPS.…”
Section: Discussionmentioning
confidence: 99%
“…Regarding treating CAPS, the consensus is to employ anticoagulants and corticosteroids in all patients [8]. While there are no randomized-controlled trials (RCTs) on specific types of anticoagulants in CAPS specifically due to low prevalence, there have been several recent studies on APS in general showing that warfarin prevents anticoagulation more efficaciously than direct oral anticoagulants (DOACs) and that DOACs increase the risk of thromboses compared to warfarin [8,9,10]. Hence, the patient was switched from apixaban to warfarin upon the suspected diagnosis of CAPS.…”
Section: Discussionmentioning
confidence: 99%