Students Research in Progress
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction: Antiphospholipid syndrome (APS) is a complex autoimmune disease that results in a hypercoagulable state. Historically, the treatment of choice for APS is lifelong anticoagulation with warfarin. For patients who have failed warfarin therapy and have contraindications to other anticoagulants such as heparin products, there is limited evidence behind the use of DOACs for treatment of APS.
Research Question or Hypothesis: We present the case of a 62-year-old male who presented with an acute right middle cerebral artery ischemic stroke for which he received a mechanical thrombectomy. His past medical history is complicated by peripheral vascular disease, with a left below the knee amputation, autoimmune hemolytic anemia, coronary artery disease, heart failure, hypercoagulability (protein S deficiency, antiphospholipid syndrome, heterozygous MTHFR C677T, heterozygous PAI 4G/5G allele) recurrent deep vein thrombosis, and heparin-induced thrombocytopenia. Home antithrombotic medications included apixaban, clopidogrel, and pentoxifylline. Patient has previously failed warfarin and ticagrelor.
Study Design: N/A
Methods: N/A
Results: Currently, most major guidelines recommend against the use of DOACs for treatment of APS. These recommendations come from trials conducted like TRAPS and ASTRO-APS which used rivaroxaban and apixaban, respectively, compared to the standard of care warfarin for the prevention of thromboembolic events in patients with APS. Particularly relevant to this patient case, the ASTRO-APS trial showed an increased risk of ischemic stroke in patients using apixaban compared to warfarin. Although these are smaller trials, the limited evidence that they provide shows that DOACs are less efficacious for the management of APS and have worse outcomes compared to warfarin.
Conclusion: Although DOACs are not recommended for the treatment of APS, it is important to be aware of the increased risk of ischemic stroke seen with apixaban. Evaluation of the risks associated with other anticoagulants in APS must be conducted when considering therapy alternatives after failure with warfarin.
Presenting Author
Taylor Bird BSUniversity of Tennessee Health Science Center College of Pharmacy
Authors
Leslie A. Hamilton PharmD, FCCP, FCCM, FNCS, BCPS, BCCCP
University of Tennessee Health Science Center College of Pharmacy
Cortney Storey PharmD
University of Tennessee Medical Center
Julia Williamson BS
University of Tennessee Health Science Center College of Pharmacy