Recurrent Thrombosis in Patients with Antiphospholipid Syndrome Receiving Newer Oral Anticoagulants: A Case Report and Review of Literature

Joshi, Akanksha; Hong, Jason; Siva, Chokkalingam

doi:10.3121/cmr.2017.1349

Cited by 15 publications

(6 citation statements)

References 17 publications

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“…Triple positivity (positivity of all three laboratory criteria for APS) was associated with a 3.5-fold increased risk of recurrent thrombosis. 107…”

Section: Neurological Manifestations In Apsmentioning

confidence: 99%

“…Triple positivity (positivity of all three laboratory criteria for APS) was associated with a 3.5-fold increased risk of recurrent thrombosis. 107 The RAPS trial, a randomized controlled, open label non-inferiority trial that compared rivaroxaban with warfarin in APS patients showed that endogenous thrombin potential (ETP) for rivaroxaban did not reach the non-inferiority threshold, but there was no increase in thrombotic risk compared with standard-intensity warfarin. It did not include patients with previous arterial manifestations or with recurrent venous thrombosis while on therapeutic warfarin dose.…”

Section: Management Of Neurologic Thrombotic Manifestationsmentioning

confidence: 99%

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Neurologic manifestations of antiphospholipid syndrome

Ricarte

Dutra

Abrantes

et al. 2018

Lupus

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Neurological involvement in antiphospholipid antibody syndrome (APS) is common, and its occurrence increases morbidity and mortality. Patients may present variable neurological involvement, such as cerebrovascular disease, cognitive dysfunction, headache, seizures, movement disorders, multiple sclerosis-like syndrome, transverse myelitis and ocular symptoms. Most neurological manifestations are associated with thrombosis of the microcirculation or of large vessels; nonetheless, there is compelling evidence suggesting that, in some cases, symptoms are secondary to an immune-mediated pathogenesis, with direct binding of aPL on neurons and glia. Herein we describe clinical characteristics and management of neurological APS manifestations.

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“…Triple positivity (positivity of all three laboratory criteria for APS) was associated with a 3.5-fold increased risk of recurrent thrombosis. 107…”

Section: Neurological Manifestations In Apsmentioning

confidence: 99%

Section: Management Of Neurologic Thrombotic Manifestationsmentioning

confidence: 99%

Neurologic manifestations of antiphospholipid syndrome

Ricarte

Dutra

Abrantes

et al. 2018

Lupus

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“…1,4,5 Until April 2018, 203 patients with APS receiving DOACs, mostly rivaroxaban (86%), along with 17 subjects on dabigatran and 11 cases on apixaban have been reported. 1,4–13 In a randomized British trial 54 patients treated with 20 mg once daily rivaroxaban were followed for 210 days and no adverse events were observed. 14 Patients with APS who developed VTE on standard-intensity anticoagulation and those following arterial thrombosis (AT) were excluded from this study.…”

Section: Introductionmentioning

confidence: 99%

Direct oral anticoagulants in patients with antiphospholipid syndrome: a cohort study

Malec

Broniatowska

Undas

2019

Lupus

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Objectives Despite controversies, direct oral anticoagulants (DOACs) are increasingly used in antiphospholipid syndrome (APS). We investigated the safety and efficacy of DOACs versus vitamin K antagonists (VKAs) in real-life consecutive APS patients. Patients and methods In a cohort study of 176 APS patients, which included 82 subjects who preferred DOACs or had unstable anticoagulation with VKAs, we recorded venous thromboembolism (VTE), cerebrovascular ischemic events or myocardial infarction, along with major bleeding or clinically relevant non-major bleeding (CRNMB). Results APS patients were followed for a median time of 51 (interquartile range 43–63) months. Patients on DOACs and those on VKAs were similar with regard to baseline characteristics. APS patients treated with DOACs had increased risk of recurrent thromboembolic events and recurrent VTE alone compared with those on VKAs (hazard ratio (HR) = 3.98, 95% confidence interval (CI): 1.54–10.28, p = 0.004 and HR = 3.69, 95% CI: 1.27–10.68, p = 0.016, respectively) with no differences between rivaroxaban and apixaban or single- or double-positive and triple-positive APS. Thromboembolism on DOACs was associated with older age (median 52 versus 42 years, p = 0.008) and higher global APS score (median 13 versus 8.5, p = 0.013). Patients on DOACs had increased risk of major bleeding or CRNMB (HR = 3.63, 95% CI: 1.53–8.63, p = 0.003), but rates of gastrointestinal bleeds (HR = 3.36, 95% CI: 0.70–16.16, p = 0.13) and major bleeds or CRNMB other than heavy menstrual bleeding (HR = 2.45, 95% CI: 0.62–9.69, p = 0.2) were similar in both treatment groups. Conclusion During long-term follow-up of real-life APS patients, DOACs are less effective and less safe as VKAs in the prevention of thromboembolism.

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“…Though unclear at this point, mechanisms of hypercoagulability similar to antiphospholipid syndrome (APS) might have a role to play in thrombosis in COVID-19 patients [ 8 ]. Lately, there has been a debate if DOAC therapy is appropriate in patients with APS as there are published reports of patients with APS who were being treated with a DOAC were found to have recurrent thromboembolic manifestations and had to be switched to Vitamin K antagonists (VKAs) [ 9 ]. This could indicate that the use of DOACs in COVID 19 may not be effective in the prevention of thrombosis in this patient population as there might be a possible role of lupus anticoagulant positivity in hypercoagulation in patients with COVID19.…”

Section: Reviewmentioning

confidence: 99%

The use of direct acting oral anticoagulants in patients with COVID-19 infection

Aly

Gupta

Singh

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

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The use of direct-acting oral anticoagulants (DOACs) has increased rapidly in the last decade; becoming the mainstay for both the prophylaxis and the treatment of venous thromboembolism in various situations including non-valvular atrial fibrillation, joint replacement surgeries and acute DVT/PE, etc. In the present times, DOACs are possibly one of the most widely prescribed medications in the developed world. The worldwide epidemic caused by COVID-19 caused significant changes in the practice of medicine worldwide. Patients who developed severe respiratory illness caused by COVID-19 were noted to develop a wide range of complications, including both arterial and venous thromboembolic complications including deep vein thrombosis and pulmonary embolism, etc. This review is an attempt to identify the role of DOACs in the treatment and prevention of these complications as well as the safety of continuing therapy with DOACs in the patients who were receiving them before contracting the infection.

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Recurrent Thrombosis in Patients with Antiphospholipid Syndrome Receiving Newer Oral Anticoagulants: A Case Report and Review of Literature

Cited by 15 publications

References 17 publications

Neurologic manifestations of antiphospholipid syndrome

Neurologic manifestations of antiphospholipid syndrome

Direct oral anticoagulants in patients with antiphospholipid syndrome: a cohort study

The use of direct acting oral anticoagulants in patients with COVID-19 infection

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