Rivaroxaban Not Noninferior to VKAs for Antiphospholipid Antibody Syndrome

Rivaroxaban, a direct oral anticoagulant (DOAC), is not noninferior to dose-adjusted vitamin K antagonists in preventing thrombotic events in patients with antiphospholipid antibody syndrome...

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Rivaroxaban, a direct oral anticoagulant (DOAC), is not noninferior to dose-adjusted vitamin K antagonists in preventing thrombotic events in patients with antiphospholipid antibody syndrome (APS), according to an industry-funded study in the Annals of Internal Medicine.

Nearly 200 adults with APS were randomized to receive rivaroxaban or continue their adjusted dose of vitamin K antagonist (VKA).

Roughly 12% of patients receiving rivaroxaban and 6% of the VKA group had recurrent thrombosis by 36 weeks, the study's primary outcome. However, the difference was not statistically significant. For the rivaroxaban group, arterial thrombosis rates were significantly higher than those of the VKA group. The rates of major bleeding were similar between treatments.

Editorialists write: "The data now available suggest that DOACs should not be prescribed for patients with high-risk APS."

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LINK(S):

Annals of Internal Medicine article (Free abstract)

Annals of Internal Medicine editorial (Subscription required)

Background: NEJM Journal Watch Oncology and Hematology coverage of rivaroxaban vs. warfarin in antiphospholipid antibody syndrome (Your NEJM Journal Watch registration required)