Uso de inhibidores directos del factor Xa en síndrome antifosfolípido: una serie de 7 casos

Abstract

BackgroundAntiphospholipid syndrome is an autoimmune disease with antibodies against membrane phospholipids with mainly thrombotic and/or obstetric manifestations. Its treatment is generally based on indefinite anticoagulation, usually with warfarin, and which, for various factors, is not always feasible, making it necessary to use alternative therapies. ObjectiveTo describe the experience with rivaroxaban in patients with antiphospholipid syndrome. Materials and methodsA descriptive study was conducted on subjects that met the 2006 Sydney criteria for antiphospholipid antibodies syndrome and received anticoagulation with rivaroxaban at 20mg daily dose in 2reference hospitals in Medellin, Colombia, between January 2012 and April 2015. ResultsThe study included 7 patients, with a mean age of 36±10.8 years (range 23-55). Four patients had venous thrombosis, 5arterial, 5were positive for anticardiolipin antibodies, 3reactive to lupus anticoagulant, 2anti-β2 glycoprotein positive subjects, and one patient had triple antiphospholipid antibody positivity. The median time of warfarin use was 15 months (RIQ 1-36). The reasons for starting rivaroxaban were: bleeding (n=2), sub-therapeutic coagulation ranges (n=2), toxicoderma, gastrointestinal intolerance, and re-thrombosis (n=1, each). The time of use was 17.9±13.4 months (range: 3-34). There were 2recurrent cases of thrombosis during follow-up, and no adverse events. ConclusionThe use of factor Xa inhibitors in a series of patients with antiphospholipid syndrome and unable to use warfarin showed an adequate safety profile; however, 2recurrent episodes of venous thrombosis occurred.