Abstract
Antiphospholipid syndrome (APS) is an autoimmune, acquired hypercoagulable disorder. It is characterized by a presence of anti-phospholipid antibodies (APA) and heterogeneous clinical manifestations, dominated by thrombosis (venous, arterial or small vessel thrombosis) and/or pregnancy complications.
Because of high risk of thrombosis recurrence, secondary antithrombotic pro-phylaxis is of critical importance. Anticoagulation represents the cornerstone of therapy, including the cases of arterial thrombosis.
Warfarin remains the first-choice therapy, usually with target INR (international normalized ratio) 2-3. Direct oral anticoagulants (DOACs) are not recommended in APS, based on the recent data.
Studies have revealed an increased risk of arterial thrombosis, especially in high-risk APS patients treated with rivaroxaban, compared to warfarin. DOACs may be considered in patients with venous thromboembolism and lower risk APS, in those not able to achieve a target INR despite good adherence, or in APS patients with warfarin allergy or intolerance.
Ongoing studies will hopefully bring new data about efficacy and safety of DOACs in APS.