Increased risk of thrombosis in antiphospholipid syndrome patients treated with direct oral anticoagulants. Results from an international patient-level data meta-analysis

Addendum to British Society for Haematology Guidelines on Investigation and Management of Antiphospholipid syndrome, 2012 (Br. J. Haematol. 2012; 157: 47–58): use of direct acting oral anticoagulants

“…Until recently, data on the role of direct acting oral anticoagulants (DOACs) in treatment of thrombotic antiphospholipid syndrome (APS) have been limited and derived from case reports, cohort studies and small prospective open‐labelled randomised controlled studies. In a meta‐analysis of 47 studies comprising a total of 447 APS patients who received DOACs, 73 patients (16%) developed a recurrent thrombosis after a mean period of 12·5 months (Dufrost et al ., ). The recurrent thrombosis occurred in 16·9% and 15% of patients receiving a factor Xa inhibitor (FXa; rivaroxaban or apixaban) or a factor IIa inhibitor (dabigatran) respectively.…”

“…Presence of all three antiphospholipid antibodies (aPL): lupus anticoagulant (LA), IgG and/or IgM anti‐beta‐2 glycoprotein‐1 and anticardiolipin antibodies, defined as ‘triple positivity’ was associated with a fourfold increased risk of recurrent thrombosis compared to patients with single or dual positive positivity [56% vs. 23%; OR = 4·3 (95% CI; 2·3–7.7), P < 0·0001]. Patients treated for arterial thrombosis with rivaroxaban or apixaban had a higher risk of recurrent thrombosis compared to those with venous thrombosis (32% vs. 14%; OR = 2·8 [95% CI; 1·4–5.7], P = 0·006) (Dufrost et al ., ).…”

27th Congress of the International Society on Thrombosis and Hemostasis

“…V. Dufrost (Франция) осветила вопросы применения прямых пероральных антикоагулянтов (ППАК) при АФС [6]. Первое описание случая назначения дабигатрана и ривароксабана трем больным АФС было опубликовано J.K. Schaefer и соавт.…”

“…• метаанализ №2 (V. Dufrost и соавт., 2019) [6]. Данная работа включала анализ 53 публикаций (5 рандомизированных плацебоконтролируемых исследований, 16 описаний серий случаев, 24 описания случаев и 9 абстрактов).…”

Antiphospholipid syndrome and direct oral anticoagulants: to the future and back again?

“…On the basis of the former randomised trial (Pengo et al, ), the European Medicines Agency, followed by several National Agencies (https://www.ema.europa.eu, 2019) recommended that direct oral anticoagulants (DOACs) should not be used for secondary prevention in APS patients with triple positivity. A systematic review of the literature including more than 400 patients (Dufrost et al, ) identified two main patient characteristics associated with recurrent thromboses in patients treated with DOACs: triple positivity of antiphospholipid test results (profile of patients included in the rivaroxaban randomised trial) and history of arterial thrombosis.…”