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Direct oral anticoagulants versus vitamin k antagonists in the secondary prvention of stroke and other thrombotic episodes in patients with antiphospholipid syndrome (Master thesis)

Μήλια - Αργείτη, Δήμητρα/ Milia - Argeiti, Dimitra

Antiphospholipid syndrome (APS) is an acquired autoimmune disorder characterized by thromboses (arterial or venous), pregnancy morbidity (mainly miscarriages) and microvascular manifestations in the presence of antiphospholipid antibodies. Cerebral circulation is the most common site of arterial thrombosis in patients with APS while APS is implicated in about 20% of strokes in younger patients. To date, the main treatment consists of administration of vitamin K antagonists with an international normalized ratio (INR) target of 2.5. Due to the difficulties in the administration profile of these drugs, a review of the existing literature was performed to compare the efficacy and safety profile of direct-acting oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients with thrombotic antiphospholipid syndrome. Randomized control trials published up to March 2024 were included in the review. Four randomized control trials with a total of 474 adult patients diagnosed with thrombotic APS that compared the efficacy and safety of DOACs versus VKAs were studied. The follow-up period varied from 6 to 36 months. A total of 32 thrombotic events occurred, of which 26 were related to DOACs and 6 to VKAs. As for strokes, a total of 20 occurred, all in patients treated with DOACs. The safety profile was assessed mainly through the occurrence of major bleeding, and no essential differences between the 2 groups were found (10 bleeds (4%) in each arm). In conclusion, newer anticoagulants do not seem to be an effective alternative to vitamin K antagonists in patients with thrombotic APS. Future studies should investigate the potential benefit of administering DOACs in low-risk patients with antiphospholipid syndrome.