Mostrar el registro sencillo del ítem

dc.contributor.authorSanchez-Redondo, Jorge
dc.contributor.authorEspinosa, Gerard
dc.contributor.authorVarillas Delgado, David 
dc.contributor.authorCervera, Ricard
dc.date.accessioned2021-01-25T09:33:45Z
dc.date.available2021-01-25T09:33:45Z
dc.date.issued2019
dc.identifier.issn0149-2918spa
dc.identifier.urihttp://hdl.handle.net/10641/2190
dc.description.abstractPurpose The treatment of thrombosis in patients with antiphospholipid syndrome (APS) usually requires long-term anticoagulation with vitamin K antagonists. The effectiveness of direct oral anticoagulants (DOACs) in APS has not been fully addressed. The purpose of this research was to analyze the efficacy (thrombotic event–free time) and tolerability (bleeding events) of DOACs in patients with APS. Methods We performed a descriptive analysis of a systematic review of data from patients with APS treated with DOACs reported in the literature, via EMBASE, PubMed, and the European League Against Rheumatism and American College of Rheumatology congresses. After systematic review, a meta-analysis of data from clinical trials was performed. Findings A total of 728 patients, accounting for 731 courses of treatment with DOACs, were identified. The majority (48.3%) presented with triple anti-phospholipid antibody positivity. The prevalence of thrombosis during DOAC treatment was 13.9%. Analysis of risk factors for recurrent thrombosis suggested that a higher mean (SD) number of prior thrombotic events (1.80 [0.87] vs 1.67 [1.45]; P = 0.012), history of combined arterial and venous thrombosis (27.3% vs 9.2% [ P < 0.0001]; odds ratio [OR] = 3.72 [95% CI, 1.91–7.25]), previous treatment with LMWH (9.8% vs 1.1% [ P = 0.04]; OR = 9.95 [95% CI, 1.08–91.97]), use of immunosuppressant treatment (41.7% vs 12.7% [ P = 0.03]; OR = 4.9 [95% CI, 1.21–19.76]), and no reason to switch anticoagulant treatment other than patient's decision (32% vs 2.8% [ P = 0.001]; OR = 16.24 [95% CI, 3.16–83.52]) were associated with a high risk for re-thrombosis. Meta-Analysis did not show statistically relevant difference in risk of thrombosis or bleeding comparing warfarin with DOACs. Implications The findings from this systematic literature review and meta-analysis suggest that patients treated with DOACs and having risk factors such as history of recurrent thrombosis, a history of combined arterial and venous thrombosis, or a need for immunosuppressant treatment, may have higer ratio of thrombotic recurrence. There are limited data to inform decisions on the use of DOACs in patients with APS with different or no risk factors.spa
dc.language.isoengspa
dc.publisherClinical Therapeuticsspa
dc.rightsAtribución-NoComercial-SinDerivadas 3.0 España*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/es/*
dc.subjectAntiphospholipid syndromespa
dc.subjectDirect oral anticoagulantsspa
dc.subjectSystematic reviewspa
dc.subjectMeta-analysisspa
dc.titleRecurrent Thrombosis With Direct Oral Anticoagulants in Antiphospholipid Syndrome: A Systematic Literature Review and Meta-analysis.spa
dc.typejournal articlespa
dc.type.hasVersionSMURspa
dc.rights.accessRightsopen accessspa
dc.description.extent1,91 MBspa
dc.identifier.doi10.1016/j.clinthera.2019.06.015spa
dc.relation.publisherversionhttps://www.clinicaltherapeutics.com/article/S0149-2918(19)30342-X/fulltextspa


Ficheros en el ítem

FicherosTamañoFormatoVer
ViewPageProof_CLITHE_3597.pdf1.920MbPDFVer/

Este ítem aparece en la(s) siguiente(s) colección(ones)

Mostrar el registro sencillo del ítem

Atribución-NoComercial-SinDerivadas 3.0 España
Excepto si se señala otra cosa, la licencia del ítem se describe como Atribución-NoComercial-SinDerivadas 3.0 España