Signorelli Flavio, Nogueira Felipe, Domingues Vinicius, Mariz Henrique Ataide, Levy Roger A
Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Clin Rheumatol. 2016 Mar;35(3):801-5. doi: 10.1007/s10067-015-3030-y. Epub 2015 Jul 30.
The current treatment for antiphospholipid syndrome (APS) with thrombotic manifestation is long-term anticoagulation. Vitamin K antagonists (VKA) are usually the agents of choice. However, VKA limitations, such as unpredictable anticoagulation effects due to interaction with diet and other drugs, require regular monitoring. This may impact on patients' quality of life. Since the approval of new oral anticoagulants (NOAC) for non-valvular atrial fibrillation and deep vein thrombosis prevention, much has been speculated about its use in APS patients. We report here a series of eight APS patients with failure of thrombotic prevention during rivaroxaban use. All patients had venous thrombosis as the initial manifestation of APS, and two of them also had arterial manifestations. Three patients had triple antibody positivity. Five patients developed arterial events during the treatment with rivaroxaban. Until the results of ongoing trials of rivaroxaban for APS are presented, NOAC should not be recommended to APS patients. Our preliminary experience as well cases previously reported in the literature suggest that there is a high-risk group that is less protected with rivaroxaban, namely those with previous arterial thrombosis or triple positivity. VKA remains to be the mainstay treatment for thrombotic APS.
目前，针对有血栓形成表现的抗磷脂综合征（APS）的治疗方法是长期抗凝。维生素K拮抗剂（VKA）通常是首选药物。然而，VKA存在局限性，例如因与饮食及其他药物相互作用而导致抗凝效果不可预测，这就需要定期监测。这可能会影响患者的生活质量。自从新型口服抗凝药（NOAC）被批准用于预防非瓣膜性心房颤动和深静脉血栓形成以来，人们对其在APS患者中的应用进行了诸多猜测。我们在此报告一系列8例使用利伐沙班期间血栓形成预防失败的APS患者。所有患者均以静脉血栓形成作为APS的初始表现，其中2例还伴有动脉表现。3例患者为三联抗体阳性。5例患者在使用利伐沙班治疗期间发生了动脉事件。在利伐沙班用于APS的正在进行的试验结果公布之前，不应向APS患者推荐NOAC。我们的初步经验以及先前文献报道的病例表明，存在一个使用利伐沙班保护效果较差的高危组，即那些既往有动脉血栓形成或三联阳性的患者。VKA仍然是血栓形成性APS的主要治疗方法。
