Ordi Ros J*, Sole Marce C and Cortes Hernande J
Department of Internal Medicine, Vall d'Hebron University Hospital, SpainFulltext PDF
Antiphospholipid Syndrome (APS) is an autoimmune acquired thrombophilia characterized by recurrent thrombosis and pregnancy morbidity in the presence of persistent antiphospholipid antibodies. Current therapeutic recommendations for thrombosis prevention in patients with APS are limited to anticoagulation with Vitamin K Antagonists (VKA) or heparins and to anti-platelet aggregating agents. Maintaining optimized anticoagulation to prevent recurrent thrombosis or bleeding remains a therapeutic challenge. Direct Oral Anticoagulants (DOACs) DOACs have been approved to prevent recurrent thrombotic events in different prothrombotic conditions, such as nonvalvular atrial fibrillation, deep vein thrombosis still aim the same target and thromboprophylaxis after elective orthopedic surgery. The mechanism of action of these new anticoagulants involves the direct inhibition of either factor Xa (rivaroxaban, apixaban, edoxaban or betrixaban) or thrombin (dabigatran etexilate), in a reversible, competitive, highly selective and dose-dependent manner In the pivotal trials, DOACs showed safety and efficacy profiles similar to those of VKAs, in conditions not related to APS. Due to their pharmacokinetic and pharmacodynamic characteristics, there are some very appealing advantages of DOACs over VKAs, namely the lack of need for laboratory monitoring, the usage of a fixed dosage for all patients, absence of significant interaction with dietary components and drugs, and rapid anticoagulant onset after drug initiation. On the other hand, assays to measure drugs levels and antidotes are not routinely available in clinical practice, raising concerns about hemorrhagic complications. Recent experiences of ribaroxaban in secondary thromboprophylaxis of APS have not been good to avoid arterial thrombosis. Therefore the use of NAOs in the APS thromboprophylaxis is debatable.
Ordi Ros J, Sole Marce C, Cortes Hernande J. New Oral Anticoagulants in Antiphospholipid Syndrome Treatment. Int J Intern Emerg Med. 2019;2(1):1017.