Use of New Oral Anticoagulants in Antiphospholipid Syndrome

Overview

Journal Curr Rheumatol Rep

Publisher Current Science

Specialty Rheumatology

Date 2013 May 8

PMID 23649961

Citations 14

Authors

Deepa Jayakody Arachchillage

Hannah Cohen

Affiliations

Soon will be listed here.

Abstract

The current mainstay of treatment of thrombotic APS is long-term anticoagulation with oral vitamin K antagonists (VKA) such as warfarin. However, the use of warfarin is problematic, particularly in patients with antiphospholipid syndrome (APS). The new oral anticoagulants (NOAC) include dabigatran etexilate (Pradaxa®), a direct thrombin inhibitor, and rivaroxaban (Xarelto®), Apixaban (Eliquis) and Edoxaban (Lixiana®), which are direct anti-Xa inhibitors. Unlike warfarin, these agents do not interact with dietary constituents and alcohol, have few reported drug interactions, and monitoring of their anticoagulant intensity is not routinely required due to their predictable anticoagulant effects. In this chapter, we discuss clinical and laboratory aspects of NOAC. These agents have been approved for several therapeutic indications based on phase III prospective randomised controlled clinical trials using warfarin at a target INR of 2.5 (i.e. range 2.0-3.0) as the comparator. However these trials may not be directly applicable to patients with antiphospholipid syndrome (APS) where prospective clinical studies of NOAC are the way forward.

Citing Articles

Advances in the Pathophysiology of Thrombosis in Antiphospholipid Syndrome: Molecular Mechanisms and Signaling through Lipid Rafts.

Capozzi A, Manganelli V, Riitano G, Caissutti D, Longo A, Garofalo T J Clin Med. 2023; 12(3).

PMID: 36769539 PMC: 9917860. DOI: 10.3390/jcm12030891.

Role of Direct Oral Anticoagulation Agents as Thromboprophylaxis in Antiphospholipid Syndrome.

Arora S, Nair S, Prabhu R, Avanthika C, Jhaveri S, Samayam S Cureus. 2021; 13(10):e19009.

PMID: 34824926 PMC: 8610415. DOI: 10.7759/cureus.19009.

Comparison of the Therapeutic Effects of Rivaroxaban Versus Warfarin in Antiphospholipid Syndrome: A Systematic Review.

Khodashahi M, Rezaieyazdi Z, Sahebari M Arch Rheumatol. 2020; 35(1):107-116.

PMID: 32637926 PMC: 7322308. DOI: 10.5606/ArchRheumatol.2020.7375.

Adrenal Hemorrhage in a Patient Anticoagulated with Apixaban with Antiphospholipid Syndrome.

Sanford Z, Nanjundappa A, Annie F, Embrey S Cureus. 2019; 11(7):e5108.

PMID: 31523539 PMC: 6741395. DOI: 10.7759/cureus.5108.

Funke A, Danowski A, Castro Oliveira De Andrade D, Rego J, Levy R J Vasc Bras. 2018; 16(2):140-149.

PMID: 29930638 PMC: 5915862. DOI: 10.1590/1677-5449.011416.

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