Oxford Handbook of Rheumatology (Oxford Medical Handbooks) by unknow

Author:unknow
Language: eng
Format: epub
Publisher: OUP Oxford
Published: 2018-06-13T21:00:00+00:00

Anticoagulation in obstetric APS

See Table 11.5.

Novel oral anticoagulants (NOACs)

•Anticoagulation with warfarin is limited by drug and food interactions, teratogenicity, high variability in response and necessity of frequent blood monitoring.

•NOACs directly inhibit a single enzyme of the coagulation cascade, and seem to be promising in the prevention of thrombosis in APS (but no APS trials).

•Minimal drug and food interactions and fixed drug dosing without the need for laboratory monitoring contribute to the advantage of NOACs compared to warfarin. However, the lack of antidotes remains a limitation. Some studies report a risk of major bleeding of up to 10% of cases per year.

•NOACs include direct thrombin inhibitors such as dabigatran, and direct anti-Xa inhibitors such as rivaroxaban, apixaban, and edoxaban. The Rivaroxaban for Antiphospholipid Antibody Syndrome (RAPS) study is currently underway comparing the effects of warfarin versus rivaroxaban in thrombotic APS patients.

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