Rivaroxaban Versus Vitamin K Antagonist in Antiphospholipid Syndrome
Authors: Derek Leong, Peter E. Wu
Journal: Annals of Internal Medicine (2020)

Letters7 April 2020Rivaroxaban Versus Vitamin K Antagonist in Antiphospholipid SyndromeDerek Leong, RPh, BScPhm and Peter E. Wu, MD, MScDerek Leong, RPh, BScPhmUniversity Health Network, University of Toronto, Toronto, Ontario, Canada (D.L., P.E.W.)Search for more papers by this author and Peter E. Wu, MD, MScUniversity Health Network, University of Toronto, Toronto, Ontario, Canada (D.L., P.E.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-0052 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read Ordi-Ros and colleagues' study (1) comparing the efficacy and safety of rivaroxaban versus vitamin K antagonists (VKAs) for secondary thromboprophylaxis in patients with antiphospholipid antibody syndrome (APS) with interest. We were surprised that rivaroxaban not only did not show noninferiority to VKAs but also was associated with a nearly 2-fold increase (albeit a statistically nonsignificant one) in thrombotic events (rivaroxaban, 11.6%, vs. VKAs, 6.3%) (1). These results were similar to those from the TRAPS (Trial on Rivaroxaban in Antiphospholipid Syndrome) study done in patients with triple-positive APS (2). Why patients receiving rivaroxaban had a higher ...References1. Ordi-Ros J, Sáez-Comet L, Pérez-Conesa M, et al. Rivaroxaban versus vitamin K antagonist in antiphospholipid syndrome. A randomized noninferiority trial. Ann Intern Med. 2019;171:685-94. [PMID: 31610549] LinkGoogle Scholar2. Pengo V, Denas G, Zoppellaro G, et al. Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood. 2018;132:1365-71. [PMID: 30002145] CrossrefMedlineGoogle Scholar3. Steffel J, Verhamme P, Potpara TS, et al; ESC Scientific Document Group. The 2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;39:1330-93. [PMID: 29562325] CrossrefMedlineGoogle Scholar4. Shimada T, Terada A, Yokogawa K, et al. Lowered blood concentration of tacrolimus and its recovery with changes in expression of CYP3A and P-glycoprotein after high-dose steroid therapy. Transplantation. 2002;74:1419-24. [PMID: 12451243] CrossrefMedlineGoogle Scholar5. Usui T, Saitoh Y, Komada F. Induction of CYP3As in HepG2 cells by several drugs. Association between induction of CYP3A4 and expression of glucocorticoid receptor. Biol Pharm Bull. 2003;26:510-7. [PMID: 12673034] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University Health Network, University of Toronto, Toronto, Ontario, Canada (D.L., P.E.W.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-0052. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRivaroxaban Versus Vitamin K Antagonist in Antiphospholipid Syndrome Josep Ordi-Ros , Luis Sáez-Comet , Mercedes Pérez-Conesa , Xavier Vidal , Antoni Riera-Mestre , Antoni Castro-Salomó , Jordi Cuquet-Pedragosa , Vera Ortiz-Santamaria , Montserrat Mauri-Plana , Cristina Solé , and Josefina Cortés-Hernández Rivaroxaban Versus Vitamin K Antagonist in Antiphospholipid Syndrome Stephan Moll Rivaroxaban Versus Vitamin K Antagonist in Antiphospholipid Syndrome Josefina Cortés-Hernández Metrics Cited byRivaroxaban Versus Vitamin K Antagonist in Antiphospholipid SyndromeJosefina Cortés-Hernández, MD, PhD 7 April 2020Volume 172, Issue 7Page: 509-510KeywordsAnticoagulantsAntiphospholipid syndromeAttentionKidneysLiverSafetySafety studiesTherapeutic drug monitoringThrombosisVitamin K ePublished: 7 April 2020 Issue Published: 7 April 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...