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Comparing APLS and oranges: caution with the use of direct-acting oral anticoagulants (DOACs) instead of warfarin in the treatment of antiphospholipid syndrome (APLS)
  1. Matthew Benger,
  2. Jasper Vink,
  3. Luke Blagdon Snell and
  4. Karen Breen
  1. Guy’s and Saint Thomas’ NHS Foundation Trust, London, UK
  1. Correspondence to Dr Luke Blagdon Snell, luke.snell{at}


A 63-year-old woman with known antiphospholipid syndrome (APLS) presented with catastrophic APLS and multiorgan dysfunction after a change in her anticoagulation from warfarin to rivaroxaban. Evidence suggests direct-acting oral anticoagulants (DOACs) like rivaroxaban may be less effective than warfarin in secondary prevention of thrombotic events in high-risk APLS patients.

  • haematology (incl blood transfusion)
  • haematology (drugs and medicines)
  • systemic lupus erythematosus

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  • Contributors MB contributed to sections on background, case presentation and differential diagnosis. Involved in redrafting of all sections. JV contributed to sections on case presentation, investigations and treatment. Involved in redrafting of all sections. LBS reviewed patient, contributed to sections on the case presentation, investigations, treatment and discussion. KB consultant clinician responsible for haematological management of case, provided advice regarding rationale of haematological management for case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.