Antiphospholipid syndrome: are old school VKAs still the best choice?

Excerpt

Thrombotic antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by recurrent arterial and/or venous thrombotic events, with heterogeneous laboratory and clinical manifestations [1]. The annual rate of first thrombotic events in individuals with any single positive antiphospholipid antibody (APL) is estimated around 0.65% (similar to the baseline risk in healthy population), compared with 1.27% in patients who are double or triple positive for APL. Moreover, the risk of a recurrent thrombotic event has been reported to be as high as 16.6% in a 5-year period [2]. Vitamin K antagonists (VKAs) are the current standard therapy for secondary prevention of thrombotic events. Direct oral anticoagulants (DOACs) are now the standard treatment for many patients with different indications. Advantages of DOACs compared to VKAs are well known and they have been compared with VKAs for APS patients in a number of clinical trials. …