Comparing APLS and oranges: caution with the use of direct-acting oral anticoagulants (DOACs) instead of warfarin in the treatment of antiphospholipid syndrome (APLS)

BMJ Case Rep. 2019 Apr 1;12(4):e227695. doi: 10.1136/bcr-2018-227695.


A 63-year-old woman with known antiphospholipid syndrome (APLS) presented with catastrophic APLS and multiorgan dysfunction after a change in her anticoagulation from warfarin to rivaroxaban. Evidence suggests direct-acting oral anticoagulants (DOACs) like rivaroxaban may be less effective than warfarin in secondary prevention of thrombotic events in high-risk APLS patients.

Keywords: haematology (drugs and medicines); haematology (incl blood transfusion); systemic lupus erythematosus.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Anticoagulants / therapeutic use
  • Antiphospholipid Syndrome / complications
  • Antiphospholipid Syndrome / drug therapy*
  • Factor Xa Inhibitors / administration & dosage
  • Factor Xa Inhibitors / adverse effects
  • Female
  • Humans
  • Middle Aged
  • Rivaroxaban / administration & dosage*
  • Rivaroxaban / adverse effects
  • Secondary Prevention*
  • Thrombosis / etiology
  • Thrombosis / prevention & control*
  • Warfarin / therapeutic use


  • Anticoagulants
  • Factor Xa Inhibitors
  • Warfarin
  • Rivaroxaban