The following is a summary of “Direct Oral Anticoagulants vs. Vitamin K Antagonists in Patients With Antiphospholipid Syndromes: Meta-Analysis of Randomized Trials,” published in the January 2023 issue of Cardiology by Khairani, et al.

Direct oral anticoagulants (DOACs) for individuals with the thrombotic antiphospholipid syndrome were still debatable regarding their effectiveness and safety. Therefore, a thorough review and meta-analysis of randomized controlled trials contrasting vitamin K antagonists (VKAs) and DOACs was carried out by researchers for a study.

Through April 9, 2022, they looked through PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. A combination of arterial thrombotic events and venous thromboembolic events (VTEs) represented the two primary efficacy outcomes. The primary safety result was significant bleeding. Inverse variance random effects models were applied.

About 253 studies were located in the search. Around 472 patients were involved in 4 open-label, randomized controlled studies (mean control-arm time-in-therapeutic range: 60%). All of them had sufficient allocation concealment and good random sequence creation. The use of DOACs as opposed to VKAs was generally linked to an elevated risk of future arterial thrombotic events, particularly stroke, and the composite of arterial thrombotic events (OR: 5.43; 95% CI: 1.87-15.75; P < 0.001, I = 0%), or VTE (OR: 4.46; 95% CI: 1.12-17.84; P = 0.03, I2 = 0%). There was no statistically significant difference between the two groups in the likelihood of future VTE (OR: 1.20; 95% CI: 0.31-4.55; P = 0.79, I2 = 0%) or serious bleeding (OR: 1.02; 95% CI: 0.42-2.47; P = 0.97; I2 = 0%). The majority of results were consistent across subgroups.

The risk of arterial thrombosis was in patients with thrombotic antiphospholipid syndrome who were randomly assigned to DOACs as opposed to VKAs. There were no discernible changes in the risk of future VTE or serious bleeding between patients who were randomly assigned to DOACs vs. VKAs.

Reference: jacc.org/doi/10.1016/j.jacc.2022.10.008