title: Thrombotic events in patients with antiphospholipid syndrome treated with rivaroxaban: a series of eight cases.
abstract: The current treatment for antiphospholipid syndrome (APS) with thrombotic manifestation is long-term anticoagulation. Vitamin K antagonists (VKA) are usually the agents of choice. However, VKA limitations, such as unpredictable anticoagulation effects due to interaction with diet and other drugs, require regular monitoring. This may impact on patients' quality of life. Since the approval of new oral anticoagulants (NOAC) for non-valvular atrial fibrillation and deep vein thrombosis prevention, much has been speculated about its use in APS patients. We report here a series of eight APS patients with failure of thrombotic prevention during rivaroxaban use. All patients had venous thrombosis as the initial manifestation of APS, and two of them also had arterial manifestations. Three patients had triple antibody positivity. Five patients developed arterial events during the treatment with rivaroxaban. Until the results of ongoing trials of rivaroxaban for APS are presented, NOAC should not be recommended to APS patients. Our preliminary experience as well cases previously reported in the literature suggest that there is a high-risk group that is less protected with rivaroxaban, namely those with previous arterial thrombosis or triple positivity. VKA remains to be the mainstay treatment for thrombotic APS.
authors.affiliation: Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. flasigno@hotmail.com.|Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. flasigno@hotmail.com.
authors.forename: Flavio
authors.initials: F
authors.lastname: Signorelli
authors.affiliation: Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Nogueira
authors.affiliation: New York University Langone Medical Center, New York University School of Medicine, New York, USA.
authors.forename: Vinicius
authors.initials: V
authors.lastname: Domingues
authors.affiliation: Faculdade de Ciências Médicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
authors.forename: Henrique Ataide
authors.initials: HA
authors.lastname: Mariz
authors.affiliation: Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.|Centro de Imunoterapia de Ipanema - CITIPA, Rio de Janeiro, Brazil.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069552:Rivaroxaban / Q000009:adverse effects* / Q000627:therapeutic use; D013927:Thrombosis / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D000069552:Rivaroxaban
keywords: Anticoagulants; Antiphospholipid syndrome; Rivaroxaban; Thrombosis; Warfarin