🚨🚨📢📢 1/ Beyond thrilled to have our article published in @JACCJournals: “Direct Oral Anticoagulants vs Vitamin-K Antagonists in Thrombotic Antiphospholipid Syndrome: Meta-analysis of Randomized Controlled Trials”
jacc.org/doi/10.1016/j.…
Key findings highlighted ⬇️
jacc.org/doi/10.1016/j.…
Key findings highlighted ⬇️
2/ #DOAC are now the standard treatment for many patients with #VTE or for those who require prevention of stroke and systemic embolism, particularly in the setting of non-valvular atrial fibrillation.
3/ A few RCTs compared #DOAC vs #VKA for treatment of patients with thrombotic APS and raised concern for ⬆️ thrombotic events with #DOAC compared to #VKA, particularly arterial thrombosis. Not sufficiently powered to assess individual thrombotic outcomes or to analyze subgroups.
4/ We conducted a systematic review and meta-analysis of RCTs that compared #DOAC to #VKA in thrombotic APS. Main efficacy outcomes were 1) composite of arterial thrombotic events and 2) composite of #VTE. Main safety outcome was MB.
5/ 4 trials were included. RAPS, TRAPS, and Ordi-Ros et al. used rivaroxaban and ASTRO-APS used apixaban. N = 474 pts. ~ duration of follow-up was 19 months. Detailed trials’ design and patients’ characteristics 👇🏻 
6/ Pooled results revealed ⬆️ odds of arterial thrombotic events in pts assigned to #DOAC compared to #VKA, mostly driven by ⬆️ odds of stroke.
8/ Results consistent among subgroups. Pts with single/double positive APS had ⬆️ risk of arterial thrombotic events just like triple APS when on #DOAC. Pts with no history of arterial thrombosis also had ⬆️ risk of arterial thrombosis with #DOAC. No differences between genders.
9/ Take-home messages: 1) Our findings do not support the routine use of existing #DOAC in pts with thrombotic APS. 2) Additional research is needed to explore potential efficacy and safety of ⬆️ doses of #DOAC and use across various subgroups in pts with thrombotic APS.
10/ BONUS: our poster presentation today at #AHA22 with simultaneous publication in JACC.
@AHAScience
@AHAScience
11/ Extremely 🙏to collaborators whose wisdom & efforts made it possible @DJC6998 @mmonrealriete @SauravChMD @vittorio_pengo @SCWollerMD @connors_md @YogenKanthi @hmkyale @MiddeldorpS @AnnaFalanga19 @MaryCushmanMD #DrPiazza #DrGoldhaber
12/ Especially grateful to my superstar colleague @CandrikaDini who co-led this work with me and our amazing mentor @bbikdeli for his incredible support!
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