Abstract Number: PB1926
Meeting: ISTH 2020 Congress
Background: Anticoagulant treatment is recommended in patients with thrombosis and antiphospholipid syndrome (APS). Conflicting results have been reported on the role of direct oral anticoagulants (DOACs) in these patients.
Aims: The primary objective was to assess the efficacy of DOACs compared to VKAs to prevent recurrence of thromboembolic events in APS patients.
Methods: We performed a meta-analysis of randomized controlled trials (RCTs) focused on this issue. We searched MEDLINE and EMBASE for RCTs comparing DOACs and vitamin K antagonists (VKAs) for secondary thromboprophylaxis in patients with thrombotic APS.
Results: Three RCTs (426 patients) were included, all comparing rivaroxaban with VKAs. VKAs were associated with reduced risk for thromboembolic recurrences (2.8% vs 9.5%; OR 0.29, 95%CI, 0.11-0.71; NNT 19 patients). The incidence of venous recurrences was similar in the two treatment groups (1.4% vs 1.4% with VKAs vs. rivaroxaban; OR 0.99, 95%CI, 0.22-4.42) while arterial recurrences were more common with rivaroxaban (1.4% vs. 8.5%; OR 0.17, 95%CI, 0.05-0.54). These differences were also present independently from the index event (OR 0.23, 95%CI, 0.07-0.77 for venous index event; OR 0.23, 95%CI, 0.07- 0.80 for arterial index event) and also in patients with triple antiphospholipid antibodies positivity (OR 0.26, 95%CI, 0.09-0.78). Similar incidences of any bleeding (17.7% vs 22.7%; OR 0.72, 95%CI, 0.44-1.18), major bleeding, (4.2% vs 4.7%; OR 0.88, 95%CI, 0.35- 2.24) and of death (1.4% vs 2.8%; OR 0.52, 95%CI, 0.14-1.96) were observed.
Conclusions: The use of rivaroxaban in APS patients is associated with an increased rate of thrombotic recurrences compared to VKAs, mainly arterial, and independently from the index event.
To cite this abstract in AMA style:Iriarte Fuster A, Cerdà Serra P, Mora Luján JM, Cortés Hernandez J, Llaberia Torrelles M, Lopez Aldabe K, Corbella Virós X, Becattini C, Riera Mestre A. Direct Oral Anticoagulants versus Vitamin K Antagonists in Antiphospholipid Syndrome: A Meta-analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/direct-oral-anticoagulants-versus-vitamin-k-antagonists-in-antiphospholipid-syndrome-a-meta-analysis/. Accessed January 28, 2022.
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