Journal List > J Rheum Dis > v.24(2) > 1064311

Park, Song, and Choi: Rivaroxaban for Thromboprophylaxis in Patients with Antiphospholipid Syndrome

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.

REFERENCES

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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.
jrd-24-108f1.tif
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.
jrd-24-108f2.tif
Figure 3.
Pulmonary embolism in the segmental bronchi of the left lower lobe (arrow).
jrd-24-108f3.tif
Figure 4.
Low attenuated filling defects (arrow) suggest deep vein thrombosis in both popliteal veins.
jrd-24-108f4.tif
Table 1.
Summary of cases of rivaroxaban use in patients with antiphospholipid syndrome
First author (ref.) Number of patient Site Duration (mo) Outcome
Current study 4 2: DVT with PE 6 No thrombosis and bleeding
    1: PE    
    1: SVT and DVT    
Bachmeyer et al. [10] 1 1: SVT - No thrombosis and bleeding
Schaefer et al. [6] 2 1: Radial arterial thrombosis 2/6 1: Stroke
    1: DVT   1: Intra/extrahepatic, splenic, and mesenteric thrombosis
Win et al. [7] 2 1: Stroke with DVT 6/- 1: SVT
    1: SVT and DVT   1: DVT
Son et al. [11] 12 12: DVT and stroke 2∼16 10: No thrombosis and bleeding
Sciascia et al. [12] 35 24: DVT 10 2: DVT No thrombosis and bleeding
    11: DVT with PE    
Noel et al. [13] 15 12: DVT and/or PE 1∼27 1: Microthrombotic recurrence
    2: Digital ischemia or ulcer   2: Bleeding
    1: Stroke   1: Migraine

Ref.: reference, DVT: deep vein thrombosis, PE: pulmonary embolism, SVT: superficial vein thrombosis, −: not described.

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