Background: Antiphospholipid syndrome is associated with high risk of thromboembolic disease in which an effective anticoagulation is essential. The data with direct oral anticoagulant in Malaysia is very limited.

Aims: To study on the effectiveness of DOAC in APLS patients.

Methods: All 16 patients with APLS were identified retrospectively for direct oral anticoagulation (DOAC) Rivaroxaban.

Results: Out of the 16 patients with APLS, 11 were on rivaroxaban 20mg daily and 5 were on rivaroxaban 15mg BD. 9 were females and 7 were males. The reason for switching from oral warfarin or low molecular weight heparin to oral rivaroxaban, namely difficult INR monitoring in 7 patients, patient’s request in 6 patients, non-compliance in 3 patients. 14 patients were diagnosed primarily with Venous Thromboembolism (VTE), one was diagnosed primarily with ischemic stroke and one was diagnosed primarily with thrombosis in unusual sites. Apart from VTE, there were two patients had arterial events and two patients had thrombosis in unusual sites. Six of them were double positive for antiphospholipid antibodies (APLA) and one was triple positive for APLA.  
Treatment Outcome: This cohort was followed-up as outpatient for at least 3 years. Three patients were switched back to warfarin. Among the three, first one had developed recurrent VTE and was complicated by Chronic Thromboembolic Pulmonary Arterial Hypertension (CTEPH); second one had recurrent DVT and third one was non-compliant to rivaroxaban. One had an episode of transient ischemic attack due to missing his medication for 2 weeks but was resumed rivaroxaban as patient’s preference. Three patients defaulted the treatment and one had migrated to New Zealand. One passed away due to Acute Coronary Syndrome. In the end, only 8 of them remained uneventful while on oral rivaroxaban.  

Conclusions: The real world experience illustrates DOAC can be a viable option for long term anticoagulation in patient with uncomplicated APLS.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/real-world-experience-use-of-doac-in-apls-patients/