New Insights into the Use of Direct Oral Anticoagulants in Non-high Risk Thrombotic APS Patients: Literature Review and Subgroup Analysis from a Meta-analysis

Curr Rheumatol Rep. 2020 May 20;22(7):25. doi: 10.1007/s11926-020-00901-y.


Purpose of review: The efficacy of direct oral anticoagulants (DOACs) in antiphospholipid syndrome (APS) is discussed. Results from randomized controlled trials are available. It has been stated that a history of arterial thrombosis and triple positivity was associated with a higher risk of thrombosis in APS patients treated with DOACs. However, their efficacy in non-high-risk APS patients with isolated venous manifestations is unsolved. Therefore, we performed a sub-group analysis of a previously published meta-analysis after the exclusion of patients with triple positivity and those with history of arterial or small vessel thrombosis.

Recent findings: We identified 290 APS patients with previous isolated venous event treated with DOACs; among them, 25 (8.6%) patients experienced a recurrent thrombosis in comparison to 16% in the original cohort. We found that the rate of recurrent thrombosis is lower in APS patients with isolated venous manifestations than in overall APS patients including high-risk patients. Research about DOAC use in non-high-risk APS patients needs to be continued.

Keywords: Antiphospholipid antibodies; Antiphospholipid syndrome; Dabigatran; Direct oral anticoagulants; Rivaroxaban; Thrombosis recurrence.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Anticoagulants* / adverse effects
  • Anticoagulants* / therapeutic use
  • Antiphospholipid Syndrome* / complications
  • Antiphospholipid Syndrome* / drug therapy
  • Humans
  • Thrombosis* / chemically induced
  • Thrombosis* / prevention & control


  • Anticoagulants