Effectiveness and safety of direct oral anticoagulants in patients with thrombotic antiphospholipid syndrome and venous thrombosis: A retrospective cohort study.

Authors

Anne Lind Malte, Anders Mønsted Abilgaard, Johanne Andersen Hojbjerg, Maja Hellfritzsch Poulsen, Erik Lerkevang Grove, Julie Brogaard Larsen

Published in

Thrombosis research. Volume 264. Pages 109759. Jun 24, 2026. Epub Jun 24, 2026.

Abstract

Vitamin K antagonists (VKA) are the recommended treatment for thrombotic antiphospholipid syndrome (TAPS), but it remains uncertain whether direct oral anticoagulants (DOAC) could serve as an alternative to VKA in a subgroup of low-risk TAPS patients with venous thromboembolism (VTE).
To compare the incidence of thrombosis recurrence between DOACs and VKAs in TAPS patients with VTE as index event.
In this retrospective cohort study, we included adults with TAPS and index VTE treated with a DOAC or VKA between January 2013 and March 2023. Outcomes were recurrent thrombosis, defined as arterial thromboembolism (ATE) or VTE, and bleeding. Cox regression with time-varying covariates was applied, adjusted for age and sex and stratified by laboratory risk profile according to the 2023 ACR/EULAR criteria.
We included 277 patients (mean follow-up 3.9 ± 2.8 years); 87% single positive. Recurrent thrombosis occurred in 26 patients (9.4%). The risk of the combined ATE/VTE outcome was higher in the DOAC group than in the VKA group, but not statistically significant (aHR 1.90, 95% CI 0.81-4.49). When analyzed separately, DOAC use was associated with more arterial events (1.34 vs. 0.51 per 100 person-years; HR = 3.72 95% CI 1.04-13.29). Major bleeding occurred in 4.0% of patients, with similar rates between treatments (aHR 0.67, 95% CI 0.34-1.31).
In TAPS patients with index VTE, DOACs were associated with more arterial recurrences, with no significant difference in the combined ATE/VTE outcome. Interpretation is limited by few events and retrospective design.

PMID:
42456240
Bibliographic data and abstract were imported from PubMed on 16 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.