Could a DOAC Replace Warfarin to Treat the Thrombotic Antiphospholipid Syndrome?

Authors:
Leslie Walters, PharmD, BCACP
Jennifer Carie, PharmD, BCACP, BC-ADM

Reviewers:
Erin Carson, PharmD, BCPS
Vivian Cheng, PharmD, BCPS
Janice Lau, PharmD

Citation:
Woller SC, Stevens SM, Kaplan D, et al. Apixaban compared with warfarin to prevent thrombosis in thrombotic antiphospholipid syndrome: A randomized trial. Blood Adv 2022; 6 (6): 1661-1670.

The Problem

The thrombotic antiphospholipid syndrome (TAPS) is typically discovered in patients who have had an atypical thromboembolic event or pregnancy loss.¹ Patients with TAPS are at very high risk of recurrent thrombotic events, either arterial or venous or both, and require indefinite or life-long anticoagulation therapy. Until about a decade ago, vitamin K antagonists (VKA) were the only oral agent available to treat and prevent thrombosis. However, VKA therapy is challenging to manage due to its narrow therapeutic index as well as multiple drug, food, and disease state interactions.^2-3 Direct anticoagulants (DOAC) have replaced warfarin and other vitamin K antagonists for several indications (e.g., stroke prevention in atrial fibrillation, venous thrombosis) due to their ease of use, absence of these interactions, and decreased monitoring burden, all of which are particularly attractive for patients who must use an anticoagulant for an indefinite period of time. Thus, a DOAC, like apixaban, would be a welcomed alternative to warfarin by many patients with TAPS.