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Inicio Medicina Clínica (English Edition) Direct-acting oral anticoagulants in antiphospholipid syndrome: A systematic rev...
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Vol. 161. Issue 2.
Pages 65-77 (July 2023)
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Vol. 161. Issue 2.
Pages 65-77 (July 2023)
Review
Direct-acting oral anticoagulants in antiphospholipid syndrome: A systematic review
Anticoagulantes de acción directa en el síndrome antifosfolípido. Revisión sistemática
José Antonio Girón-Ortegaa,
Corresponding author
jagironortega@gmail.com

Corresponding author.
, José Antonio Girón-Gonzálezb
a Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Servicio de Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
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Tables (3)
Table 1. Clinical trials examining efficacy and safety of direct-acting oral anticoagulants in antiphospholipid syndrome.
Table 2. Cohort studies examining efficacy and safety of direct-acting oral anticoagulants in antiphospholipid syndrome.
Table 3. Meta-analyses examining the efficacy and safety of direct-acting oral anticoagulants in antiphospholipid syndrome.
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Abstract

The objective of the systematic review is to analyze the efficacy of direct-acting oral anticoagulants (DOAC) in the prophylaxis of thrombosis in antiphospholipid syndrome (APS). We searched for clinical trials, cohort studies and meta-analyses published from January 1, 2012 to September 30, 2022. Articles that analysed the efficacy of DOAC in the prevention of thrombosis recurrence, with or without comparison with antivitamin K (VKA) drugs, were selected.DOACs, specifically rivaroxaban and apixaban, were significantly less effective than VKAs in preventing recurrence of thrombosis in patients with APS and prior arterial thrombosis or the concomitant presence of two or three different antiphospholipid antibodies. The proportion of patients with severe bleeding as side effect are similar in those treated with DOAC and with VKA.The results argue against the use of DOAC in the treatment of patients with thrombotic APS.

Keywords:
Antiphospholipid syndrome
Arterial thrombosis
Venous thrombosis
Direct oral anticoagulants
Warfarin
Acenocoumarol
Secondary prevention
Resumen

El objetivo de la revisión sistemática es analizar la eficacia de los anticoagulantes orales de acción directa (ACOD) en la profilaxis de trombosis en el síndrome antifosfolípido (SAF). Se realizó una búsqueda de los ensayos clínicos, estudios de cohortes y metanálisis publicados desde el 1 de Enero de 2012 hasta el 30 de Septiembre de 2022. Se seleccionaron los trabajos que analizaban la eficacia de ACOD en la prevención de la recurrencia de la trombosis, con o sin comparación con fármacos antivitamina K (AVK). Los ACOD, en concreto rivaroxaban y apixaban, fueron significativamente menos eficaces que los AVK en la prevención de la recurrencia de trombosis en enfermos con SAF y trombosis arterial previa o presencia concomitante de dos o tres anticuerpos antifosfolípido distintos. La proporción de enfermos con hemorragia grave como efecto secundario es similar en los tratados con ACOD y con AVK. Los resultados arguyen contra el empleo de ACOD en el tratamiento de enfermos con SAF trombótico.

Palabras clave:
Síndrome antifosfolípido
Trombosis arterial
Trombosis venosa
Anticoagulantes orales de acción directa
Warfarina
Acenocumarol
Prevención secundaria

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