Role of Direct Oral Anticoagulation Agents as Thromboprophylaxis in Antiphospholipid Syndrome

Abstract

Antiphospholipid syndrome (APS) is an autoimmune disorder that causes venous, arterial and small-vessel thrombosis, pregnancy loss, and premature birth. Cardiac valvular disease, renal thrombotic microangiopathy, thrombocytopenia, hemolytic anemia, and cognitive impairment are some of its other clinical symptoms. Antiphospholipid antibodies cause endothelial cells, monocytes, and platelets to become activated, as well as an increase in tissue factor and thromboxane A2. Complement activation might play a key function in pathogenesis.Long-term oral anticoagulation is used to treat thrombosis, and individuals having arterial episodes should be treated quickly. Patients with systemic lupus erythematosus (SLE), as well as those with solely obstetric antiphospholipid syndrome, should get primary thromboprophylaxis. Obstetric care is based on a combination of medical and obstetric high-risk management, as well as aspirin and heparin therapy. Possible supplementary therapy for this condition is hydroxychloroquine. Statins, rituximab, and novel anticoagulant medicines are all potential future treatments for non-pregnant individuals with antiphospholipid syndrome. We aim to review the role of direct-acting oral anticoagulants (DOACs) as thromboprophylactic drugs in the treatment of APS in this article.The treatment of venous thromboembolism has been transformed by a new class of DOACs. These drugs, such as rivaroxaban, function by inhibiting factor Xa directly. Not only do they have known anticoagulant actions, but they also obviate the need for dosage monitoring and modification, in contrast to warfarin.We conducted an exhaustive literature search of PubMed/MEDLINE and Google Scholar Indexes using the keywords "Antiphospholipid syndrome," "thromboprophylaxis," and "oral anticoagulants" up to September 2021. We found that DOACs have been shown to be non-inferior to warfarin in a variety of anticoagulation situations in a number of high-powered clinical studies. In many hypercoagulable conditions such as APS, DOACs are quickly establishing themselves as first-line therapy. This article is focused on comprehensively reviewing the mechanism of action of DOACs, their role as thromboprophylactic drugs, risks and complications of DOACs, and comparing their efficacy with the standard treatment protocol and warfarin.

Novel Inhibitors and Activity-Based Probes Targeting Trypsin-Like Serine Proteases

“…For example, Apixaban and Rivaroxaban (both of which inhibit factor Xa) and Dabigatran (a thrombin inhibitor), are now routinely used for the prevention of thromboembolic events that can occur after orthopaedic surgery to replace hip and knee joints ( Samama, 2011 ; Samama et al, 2020 ; Hasan et al, 2021 ). These drugs have also been approved for use as prophylactics in reducing venous and arterial thrombosis, and for stroke prevention in patients with atrial fibrillation ( Harter et al, 2015 ; Schulman et al, 2017 ; Chen et al, 2020 ; Arora et al, 2021 ; Bulwa et al, 2021 ).…”

The role of monocytes in thrombotic diseases: a review

“…There are currently many anticoagulant drugs of choice in clinical practice, such as DOAC rivaroxaban and warfarin drugs. Compared with warfarin, DOAC rivaroxaban not only provides anticoagulation but also reduces the frequency of bleeding events and does not require patient diet control (197).…”

Uso de los nuevos anticoagulantes orales en el síndrome antifosfolipidico: revisión bibliográfica

“…-Primario: Cuando se presenta en ausencia de cualquier otra enfermedad relacionada, es decir de forma aislada (13).…”

“…Legault K; et al (21) en su investigación realizada en Canadá, el estudio piloto y de viabilidad el cual se realizó con 129,8 pacientes no notifico acontecimientos adversos inesperados, ni de hemorragias graves, a pesar de ellos si se reportaron muy pocos efectos adversos en cuanto a infecciones de vías respiratorias, gastrointestinales, dermatológicas y neurológicas, de forma similar Arora et al (3) en su estudio realizado en Estados Unidos (2021) refiere que el riesgo global de complicaciones utilizando anticoagulantes orales directos a dosis terapéuticas es el mismo que el de los antagonistas de la vitamina K, contrario a esto el estudio realizado por Tumian; et al (13) demostró que las personas tratadas con rivaroxabán, el cual es en anticoagulante oral directo más estudiado (RR 14,1, IC del 95 %: 1,9 a 106,8) presentaban un riesgo mayor de accidente cerebrovascular, a pesar de ello el riego de sufrir un evento de sangrado mayor no fue significativo.…”