Schulz Annabel, Herrmann Eva, Ott Olivia, Lindhoff-Last Edelgard
Coagulation Centre, Cardiology Angiology Centre Bethanien Hospital (CCB), 60389 Frankfurt, Germany.
Coagulation Research Centre Bethanien Hospital, 60389 Frankfurt, Germany.
J Clin Med. 2022 Aug 18;11(16):4845. doi: 10.3390/jcm11164845.
Background: The particular challenge in dealing with patients with thromboembolic antiphospholipid syndrome (APS) is to establish an adequate therapy regime, as patients suffer from an increased risk of relapse despite antithrombotic treatment (ATT). Vitamin K antagonists (VKA) are the standard medication of choice. The current data on the use of direct oral anticoagulants (DOAC) in APS patients remain limited. Methods: The results of the retrospective APSantiCO registry are presented. In 80 patients with APS, the efficacy and safety of different ATT regimens were analyzed. Results: At the time of inclusion, 43.8% of patients were treated with VKA and 36.3% with DOAC. Medication regimes changed several times and 279 treatment phases were further analyzed with a total treatment length of 7529 months. The incidence of recurrent arterial thrombosis was significantly larger in the DOAC group compared with the VKA group (p < 0.001), while the incidence of recurrent venous thrombosis was comparable between both groups, as was the incidence of bleedings. Heavy menstrual bleeding was the most frequently observed bleeding complication. Conclusions: The data suggest that DOAC may be an alternative to VKA for APS patients with venous thromboembolism, while VKA should be used in APS-related arterial thrombosis.
治疗血栓栓塞性抗磷脂综合征（APS）患者面临的特殊挑战是建立适当的治疗方案，因为尽管进行了抗栓治疗（ATT），患者复发风险仍会增加。维生素K拮抗剂（VKA）是标准的首选药物。目前关于直接口服抗凝剂（DOAC）用于APS患者的数据仍然有限。方法：介绍了回顾性APSantiCO注册研究的结果。对80例APS患者不同ATT方案的疗效和安全性进行了分析。结果：纳入时，43.8%的患者接受VKA治疗，36.3%的患者接受DOAC治疗。用药方案多次改变，对279个治疗阶段进行了进一步分析，总治疗时长为7529个月。与VKA组相比，DOAC组复发性动脉血栓形成的发生率显著更高（p<0.001），而两组复发性静脉血栓形成的发生率相当，出血发生率也相当。月经过多是最常见的出血并发症。结论：数据表明，对于有静脉血栓栓塞的APS患者，DOAC可能是VKA的替代药物，而VKA应用于与APS相关的动脉血栓形成。
