Rivaroxaban & APS

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While the newer oral anticoagulants targeting factor Xa and thrombin have been in clinical use for several years now, they have not made their way into APS treatment till recently. This is mainly due to reports of recurrent thrombosis in such patients when they were switched from Heparin or Warfarin to Rivaroxaban (Xarelto) or Dabigatran (Pradaxa).
With this recent head-to-head study pitting Rivaroxaban against standard-intensity Warfarin showing equivalence, things may be changing. The ease of dosing of Rivaroxaban without need for (or easy access to) titration or monitoring is tempered by the exorbitant cost of the medication. For APS, we’re talking lifetime usage, usually.

Failure of dabigatran and rivaroxaban to prevent thromboembolism in antiphospholipid syndrome: a case series of three patients

Thromb Haemost. 2014 Nov;112(5):947-50. doi: 10.1160/TH14-03-0272. Epub 2014 Aug 14. Case Reports
ncbi.nlm.nih.gov|By Schaefer JK , et al.

New oral anticoagulants may not be effective to prevent venous thromboembolism in patients with antiphospholipid syndrome

American Journal of Hematology Explore this journal > Explore this journal > Previous article in issue: BCR-ABL1 kinase domain mutational analysis of CD34+ stem/progenitor cells in newly diagnosed CML patients by next-generation sequencing Previous article in issue: BCR-ABL1 kinase domain mutational…

Rivaroxaban versus warfarin to treat patients with thrombotic antiphospholipid syndrome, with or without systemic lupus erythematosus (RAPS): a randomised, controlled, open-label, phase 2/3, non-inferiority trial

ETP for rivaroxaban did not reach the non-inferiority threshold, but as there was no increase in thrombotic risk compared with standard-intensity warfarin, this drug could be an effective and safe alternative in patients with antiphospholipid syndrome and previous venous thromboembolism.