NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

DOACs and Antiphospholipid Syndrome

Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome

Following an EU review, the Summary of Product Characteristics (SPCs) for all DOACs have been updated.

Key messages

  • DOACs are not recommended for patients with a history of thrombosis who are diagnosed with antiphospholipid syndrome. In particular for patients that are triple positive, treatment with DOACs could be associated with increased rates of recurrent thrombotic events compared with vitamin K antagonist therapy.
  • All patients in GGC with antiphospholipid syndrome, a history of previous venous thrombosis, and on a DOAC should be referred to a specialist haematologist for consideration of transferring to warfarin. 

A clinical trial has shown an increased risk of recurrent thrombotic events associated with rivaroxaban compared with warfarin, in patients with triple antibody positive antiphospholipid syndrome and a history of arterial or venous thrombosis.  (Refer to the MHRA Drug Safety Update  for further details on the trial).

Having considered the evidence, the haematologists in GGC who specialise in managing patients with venous thrombosis, recommend that any patient with a diagnosis of antiphospholipid syndrome who has had a previous venous thrombosis and on a DOAC, should be referred to a specialist haematologist for consideration of transferring to warfarin.

Please note, this advice DOES NOT refer to patients with antiphospholipid syndrome who are on anticoagulation solely for atrial fibrillation without previous thrombosis history.

 

Published 23/09/19. Medicines Update blogs are correct at the time of publication.