Al Sulaiman Khalid, Alsuwayyid Faisal, Alrashidi Abdulrahman, Alhijris Mohammed, Almutairi Faisal, Alharthi Fahad, Abu Esba Laila Carolina, Aljuhani Ohoud, Badreldin Hisham A
Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
J Blood Med. 2022 Mar 3;13:105-111. doi: 10.2147/JBM.S344083. eCollection 2022.
Historically, warfarin was the mainstay anticoagulant agent to manage patients presenting with thrombotic disorders caused by Protein C or S deficiency. Several direct oral anticoagulants (DOACs) were introduced over the past decade. They showed superiority over warfarin in patients with venous thromboembolism in many landmark trials. Insufficient data are available that examine the outcome of utilizing apixaban in patients with protein S deficiency induce thrombosis.
We reported the clinical outcomes of utilizing apixaban in four patients with systemic thrombosis caused by protein C or S deficiency who presented to a tertiary hospital in Riyadh, Saudi Arabia. Four patients exhibited typical features of thrombotic events. After confirming the diagnosis, one patient was initially started on apixaban, and the other three patients were converted from warfarin to apixaban. Three of the four patients tolerated the apixaban during the follow-up period. Additionally, they did not have any bleeding or thrombotic complications. However, one patient developed recurrent thrombotic events despite switching to different type of DOAC and was ultimately transitioned back to warfarin.
Based on the available emerging evidence and our case series, the use of apixaban could be effective in preventing recurrent thrombotic events in patients with inherited thrombophilia without safety concerns. Further, large studies are warranted to investigate the safety and efficacy of apixaban in these population.
从历史上看，华法林是治疗因蛋白C或S缺乏引起的血栓形成疾病患者的主要抗凝剂。在过去十年中引入了几种直接口服抗凝剂（DOACs）。在许多具有里程碑意义的试验中，它们在静脉血栓栓塞患者中显示出优于华法林的效果。目前尚无足够数据来研究在蛋白S缺乏诱导血栓形成的患者中使用阿哌沙班的结果。
我们报告了在沙特阿拉伯利雅得一家三级医院就诊的4例因蛋白C或S缺乏引起全身血栓形成的患者使用阿哌沙班的临床结果。4例患者均表现出典型的血栓形成事件特征。确诊后，1例患者最初开始使用阿哌沙班，另外3例患者从华法林转换为阿哌沙班。4例患者中有3例在随访期间耐受阿哌沙班。此外，他们没有任何出血或血栓形成并发症。然而，1例患者尽管换用了不同类型的DOAC仍发生复发性血栓形成事件，最终转回使用华法林。
基于现有的新证据和我们的病例系列，使用阿哌沙班可能有效预防遗传性易栓症患者的复发性血栓形成事件，且无安全问题。此外，有必要进行大规模研究以调查阿哌沙班在这些人群中的安全性和有效性。
