Our September 2026 QQ asked: In your facility, what AC do you use for LAC patients with VTE? Our 13 respondents answered:
- Anti-Xa DOAC: 5 (39%)
- Warfarin: 8 (61%)
No one chose an anti-IIa DOAC, aspirin, or “none.”
There have been provocative discussions among KOL experts comparing the long-term use of warfarin (VKA) v. anti-Xa DOACs. Here is an open article that reports retrospective cohort data: Lind Malte A, Abilgaard AM, Hojbjerg JA, Poulsen MH, Grove EL, Larsen JB. Effectiveness and safety of direct oral anticoagulants in patients with thrombotic antiphospholipid syndrome and venous thrombosis: A retrospective cohort study. Thromb Res. 2026;264:109759. doi: 10.1016/j.thromres.2026.109759. PMID: 42456240.
Abstract
Background: VKAs are the recommended treatment for TAPS, but it remains uncertain whether DOACs could serve as an alternative to VKA in a subgroup of low-risk TAPS patients with VTE.
Objectives: To compare the incidence of thrombosis recurrence between DOACs and VKAs in TAPS patients with VTE as the index event.
Methods: In this retrospective cohort study, we included adults with TAPS and index VTE treated with a DOAC or VKA between January 2013 and March 2023. Outcomes were recurrent thrombosis, defined as ATE or VTE, and bleeding. Cox regression with time-varying covariates was applied, adjusted for age and sex and stratified by laboratory risk profile according to the 2023 ACR/EULAR criteria.
Results: We included 277 patients (mean follow-up 3.9 ± 2.8 years); 87% were single positive. Recurrent thrombosis occurred in 26 patients (9.4%). The risk of the combined ATE/VTE outcome was higher in the DOAC group than in the VKA group, but not statistically significant (aHR 1.90, 95% CI 0.81-4.49). When analyzed separately, DOAC use was associated with more arterial events (1.34 vs. 0.51 per 100 person-years; HR = 3.72 95% CI 1.04-13.29). Major bleeding occurred in 4.0% of patients, with similar rates between treatments (aHR 0.67, 95% CI 0.34-1.31).
Conclusion: In TAPS patients with index VTE, DOACs were associated with more arterial recurrences, with no significant difference in the combined ATE/VTE outcome. Interpretation is limited by the few events and the retrospective design.
The Mayo Clinic has invited individuals to join “The ANSWERS Study,” designed to better understand APS pathophysiology and to aid development of targeted therapeutics.
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