title: Non-vitamin K antagonist oral anticoagulants and antiphospholipid syndrome.
abstract: The current treatment of thrombotic APS patients includes long-term anticoagulation with oral vitamin K antagonists (VKAs), with warfarin being the one most commonly used. However, the use of VKAs can be challenging, especially in patients with APS. VKAs monitoring in patients with aPL is complicated by the heterogeneous responsiveness to LAs of reagents used in the International Normalized Ratio test, potentially resulting in instability of anticoagulation. For decades, VKAs were the only available oral anticoagulants. However, non-VKA oral anticoagulants, including a direct thrombin inhibitor (dabigatran etexilate) and direct anti-Xa inhibitors (rivaroxaban, apixaban and edoxaban), are currently available. The use of these agents may represent a major step forward since, unlike VKAs, they have few reported drug interactions and they do not interact with food or alcohol intake, thereby resulting in more stable anticoagulant intensity. Most importantly, monitoring their anticoagulant intensity is not routinely required due to their predictable anticoagulant effects. In this review, we discuss the clinical and laboratory aspects of non-VKA oral anticoagulants, focusing on the available evidence regarding their use in patients with APS.
authors: Center of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, University of Turin, Turin, Italy, savino.sciascia@unito.it.
authors: Savino
authors: S
authors: Sciascia
authors: Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain.
authors: Chary
authors: C
authors: Lopez-Pedrera
authors: Center of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, University of Turin, Turin, Italy.
authors: Irene
authors: I
authors: Cecchi
authors: Center of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, University of Turin, Turin, Italy.
authors: Clara
authors: C
authors: Pecoraro
authors: Center of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, University of Turin, Turin, Italy, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italya and.
authors: Dario
authors: D
authors: Roccatello
authors: Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: Maria Josè
authors: MJ
authors: Cuadrado
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000188:drug therapy*; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects; D001942:Breast Feeding; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D018565:Food-Drug Interactions / Q000502:physiology; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008107:Liver Diseases / Q000150:complications; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D016682:Lupus Coagulation Inhibitor; D014812:Vitamin K
keywords: anti-phospholipid antibodies; anti-phospholipid syndrome; apixaban; dabigatran; rivaroxaban; thrombosis