Use of direct oral anticoagulants in patients with thrombotic antiphospholipid syndrome: Guidance from the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis

Stéphane Zuily; Hannah Cohen; David Isenberg; Scott C Woller; Mark Crowther; Virginie Dufrost; Denis Wahl; Caroline J Doré; Adam Cuker; Marc Carrier; Vittorio Pengo; Katrien M J Devreese

doi:10.1111/jth.14935

Use of direct oral anticoagulants in patients with thrombotic antiphospholipid syndrome: Guidance from the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis

J Thromb Haemost. 2020 Sep;18(9):2126-2137. doi: 10.1111/jth.14935.

Authors

Stéphane Zuily^{1

2}, Hannah Cohen^{3

4}, David Isenberg⁵, Scott C Woller^{6

7}, Mark Crowther⁸, Virginie Dufrost^{1

2}, Denis Wahl^{1

2}, Caroline J Doré⁹, Adam Cuker¹⁰, Marc Carrier¹¹, Vittorio Pengo¹², Katrien M J Devreese¹³

Affiliations

¹ Division of Vascular Medicine and Regional Competence Centre for Rare Vascular and Systemic Autoimmune Diseases, Nancy Academic Hospital, Nancy, France.
² Inserm UMR_S 1116, Lorraine University, Nancy, France.
³ Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK.
⁴ Haemostasis Research Unit, Department of Haematology, University College London, London, UK.
⁵ Centre for Rheumatology, Division of Medicine, University College London, London, UK.
⁶ Department of Medicine, Intermountain Medical Center, Murray, UT, USA.
⁷ Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
⁸ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁹ Comprehensive Clinical Trials Unit, University College London, London, UK.
¹⁰ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹¹ Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, Ontario, Canada.
¹² Cardiology Clinic, Department of Cardiac-Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
¹³ Coagulation Laboratory, Department of Diagnostic Sciences, Ghent University Hospital, Ghent, Belgium.

PMID: 32881337
DOI: 10.1111/jth.14935

Abstract

Clarity and guidance is required with regard to the use of direct oral anticoagulants in antiphospholipid syndrome (APS) patients, within the confines of the recent European Medicines Agency recommendations, discrepant recommendations in other international guidelines and the limited evidence base. To address this, the Lupus Anticoagulant/Antiphospholipid Antibodies Scientific and Standardization Committee (SSC) chair and co-chairs together with SSC Control of Anticoagulation members propose guidance for healthcare professionals to help them manage APS patients. Uncertainty in this field will be addressed. This guidance will also serve as a call and focus for research.

Keywords: antiphospholipid antibodies; antiphospholipid syndrome; arterial thrombosis; direct oral anticoagulants; triple positivity; venous thromboembolism; vitamin K antagonists.

MeSH terms

Anticoagulants / therapeutic use
Antiphospholipid Syndrome* / complications
Antiphospholipid Syndrome* / diagnosis
Antiphospholipid Syndrome* / drug therapy
Humans
Lupus Coagulation Inhibitor
Reference Standards
Thrombosis* / drug therapy
Thrombosis* / prevention & control

Substances

Anticoagulants
Lupus Coagulation Inhibitor