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Abstract
The main treatment for Antiphospholipid syndrome (APS) is long-term anticoagulation with an oral vitamin K antagonist, although these are associated with numerous problems. Rivaroxaban is a direct anti-factor Xa inhibitor, with a predictable anti-coagulant effect at fixed doses. There are limited reports of rivaroxaban use in APS. We present four cases of patients with APS who received rivaroxaban treatment for six months without thrombosis recurrence or bleeding. Three of the patients received rivaroxaban as initial therapy. In the systematic review, only five patients were treated with rivaroxaban as a thromboprophylaxis. Of the 71 cases of rivaroxaban use including our study, there were seven cases (9.9%) of thrombosis recurrence and two reports of bleeding. The efficacy of rivaroxaban in APS patients was at least equal to warfarin therapy. This report and systematic review suggest that rivaroxaban can be considered cautiously as a thromboprophylactic or alternative therapy for warfarin in patients with APS.
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Figure 1.
(A) Low attenuated filling defect (arrow) involving the pulmonary artery of the right lower lobe suggestive of a pulmonary embolism at the time of diagnosis. (B) Low attenuated filling defect (arrow) in the inferior vena cava suggestive of deep vein thrombosis at the time of diagnosis. (C) Completely disappeared filling defect (arrow) of pulmonary arteries of the right lower lobe at 10 months after diagnosis. (D) Partially disappeared but still remained small portion of filling defect (arrow) in the inferior vena cava at 10 months after diagnosis.
Figure 2.
(A) Multiple low attenuated filling defects (arrows) in both pulmonary arteries suggestive of pulmonary embolisms at the time of diagnosis. (B) Low attenuated filling defect (arrow) in the left popliteal vein suggestive of deep vein thrombosis at the time of diagnosis. (C) Disappeared filling defects (arrow) in both pulmonary arteries at 10 months after diagnosis. (D) No discernible filling defect (arrow) in the left popliteal vein at 10 months after diagnosis.
Figure 4.
Low attenuated filling defects (arrow) suggest deep vein thrombosis in both popliteal veins.
Table 1.
Summary of cases of rivaroxaban use in patients with antiphospholipid syndrome
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