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. Author manuscript; available in PMC: 2024 Jan 3.
Published in final edited form as: J Am Coll Cardiol. 2022 Oct 31;81(1):16–30. doi: 10.1016/j.jacc.2022.10.008

Central Illustration. Use of DOACs versus VKAs in thrombotic APS.

Central Illustration.

In this systematic review and meta-analysis of RCTs comparing DOACs to VKAs in patients with thrombotic APS, the results were limited by the small number of patients (472 among 4 studies) and the open-label status of the trials. Overall results indicated that in patients with thrombotic APS, DOACs were associated with significantly increased odds of subsequent arterial thrombotic events, an effect that appeared mostly driven by the increased rate of stroke, compared with VKAs. No significant differences were observed with regards to the odds of VTE or major bleeding. There was no major modification of the effect across subgroups. These results would favor the use of VKAs in patients with thrombotic APS. APS = antiphospholipid syndrome; DOACs = direct oral anticoagulants; RCTs = randomized controlled trials; VKAs = vitamin-K antagonists, VTE = venous thromboembolism.