Direct oral anticoagulants antiphospholipid syndrome: Systematic Review and meta-analysis

Abstract

Introduction: Antiphospholipid syndrome (APS) is an autoimmune pathology associating defined clinical and biological criteria. The current treatment of secondary thromboses relies on vitamin K antagonists (VKA). The aim of our work is to study the efficacy and safety in SAPL of direct oral anticoagulants (DOAC). Materials and methods: We conducted a systematic review followed by a meta-analysis that included 26 studies focused on the use of DOAC in APS. The effectiveness of the treatment was estimated by the recurrence or not of the thrombosis while the safety was evaluated by the occurrence of bleeding. Results: The general recurrence of thrombosis despite treatment with DOAC was observed in 13.3% of patients. In 2.2% of the patients, hemorrhages of varying severity were reported, but no life-threatening hemorrhages were identified. The meta-analysis allowed us to demonstrate significance between antecedent arterial thromboses and the thrombotic recurrence under DOAC. There was also a greater risk of recurrence in case of triple positivity. Finally, we have highlighted the involvement of both LA and anti-β2 GPI in the occurrence of a thrombotic event during DOAC treatment. Conclusion: Larger clinical trials could clarify the place of DOAC versus the reference treatment.