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  • Would you use novel oral anticoagulants (NOACs) for thromboprophylaxis in patients with an underlying hypercoagulable state? A literature review through a case report

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Reminder of important clinical lesson
Case report
Would you use novel oral anticoagulants (NOACs) for thromboprophylaxis in patients with an underlying hypercoagulable state? A literature review through a case report
  1. Bhavika Kakadia1,
  2. Giselle Alexandra Suero-Abreu2,
  3. Rrita Daci3 and
  4. Ryna Karina Then1,4
  1. 1Neurology, Cooper Hospital University Medical Center, Camden, New Jersey, USA
  2. 2Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  3. 3Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  4. 4Neurology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
  1. Correspondence to Dr Bhavika Kakadia; bhavika.kakadia{at}gmail.com

Abstract

Antiphospholipid syndrome (APLS) is an autoimmune condition that predisposes to venous and arterial thrombosis. Warfarin is the agent of choice for anticoagulation. However, a need for routine international normalised ratio (INR) checks and multiple drug interactions are some of the difficulties with warfarin. Currently, there is mixed evidence for and against the use of novel oral anticoagulants (NOACs) for thromboprophylaxis. We present a case report of a patient with APLS on a NOAC for secondary thromboprophylaxis who developed a stroke and discuss current evidence regarding the use of NOACs in patients with APLS. The patient was switched to warfarin for secondary thromboprophylaxis with an INR goal of 2–3. Literature review revealed mixed case reports for and against NOACs for secondary prevention of thrombotic events in patients with APLS. There needs to be further randomised controlled trials to evaluate the efficacy of NOACs for thromboprophylaxis in patients with APLS.

  • stroke
  • warfarin therapy
  • haematology (incl blood transfusion)
  • rheumatology

https://doi.org/10.1136/bcr-2020-237238

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    Footnotes

    • Contributors BK and RT were involved in conception and design of the study. BK, GS, RD and RT conducted background research. BK drafted the manuscript. BK, GS, RD and RT were involved with editing and revisions.

    • 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.

    • Patient consent for publication Obtained.

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