Abstract Number: PB2444
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment
Background: Current guidelines for management of antiphospholipid syndrome (APS) recommend patients with unprovoked thrombosis have lifelong anticoagulation to prevent recurrence. This has been mainly with vitamin K antagonists (VKAs), but recently, direct oral anticoagulants (DOACs) have been used for management of venous thromboembolism (VTE)
There is limited data regarding efficacy and safety of DOACs in APS. A randomised trial comparing VKAs with rivaroxaban in ‘triple positive’ APS was stopped early due to high rates of arterial thrombosis and bleeding with rivaroxaban. Subsequently, the EMA issued recommendations to avoid DOACs in APS.
Aims: To evaluate use of DOACs in patients with APS with VTE at a tertiary level specialist centre.
Methods: We reviewed outcomes of patients at our institution during 2019, who had APS according to International Consensus statement criteria, and had taken a DOAC for prevention of recurrence following a diagnosis of VTE.
Results: 47 patients were included; 35 male, 12 female, median age 53 (range 26-81) years. 24 (51%) had single, 11 (23%) double, and 12 (25%) triple antiphospholipid positivity.
Median time of use with DOAC was 42 months (range 3-72). 29 (62%) had initial treatment with warfarin, 1 with LMWH (2%) and 17 with DOACs (36%). Patients took warfarin for a median time of 12 months (range 6 – 324), prior to switching to DOACs (rivaroxaban n=41, apixaban n=5, dabigatran n=1). All patients were counselled regarding DOACs in APS, 5 switched back to warfarin (3 with triple positive APS).
1 patient experienced VTE recurrence (upper limb DVT) but had thoracic outlet syndrome and one had an episode of thrombophlebitis. There were no major bleeding events.
Conclusions: We have demonstrated DOAC use in a patient cohort with predominantly single or dual aPL positivity and previous VTE that their use appears to be efficacious and safe. Further study is however required to confirm these findings.
To cite this abstract in AMA style:
Breen KA, Doyle A, Hunt BJ. Single Centre Experience of DOAC Use in Patients with Antiphospholipid Syndrome (APS) with Venous Thromboembolism [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/single-centre-experience-of-doac-use-in-patients-with-antiphospholipid-syndrome-aps-with-venous-thromboembolism/. Accessed October 1, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/single-centre-experience-of-doac-use-in-patients-with-antiphospholipid-syndrome-aps-with-venous-thromboembolism/