Tahereh Yavari: DOACs vs Warfarin in Antiphospholipid Syndrome
Tahereh Yavari, Assistant Professor at Tehran University of Medical Sciences, shared a post on LinkedIn about a paper by Alessandra Ida Celia et al. published in Seminars in Arthritis and Rheumatism:
“DOACs vs Warfarin in Antiphospholipid Syndrome: What Does the Evidence Say in 2025?
A major new systematic review and meta-analysis by Alessandra Ida Celia, Giovanni Maria Vescovo, Cristiano Alessandri, Fabrizio Conti, Behnood Bikdeli, Michelle Petri, Andrea Fava, Mattia Galli published in Seminars in Arthritis and Rheumatism (2025), sheds new light on one of the most debated clinical questions in APS management.
The Numbers Tell the Story
Across 12 studies (4 RCTs + 8 observational; 1,307 patients)
- Composite thrombotic events were > 2× higher with DOACs vs VKAs – IRR 2.33 (95 % CI 1.18 – 4.58)
- Arterial thrombosis risk tripled – IRR 2.70 (1.42 – 5.13)
- Venous thrombosis: no significant difference – IRR 0.98 (0.59 – 1.64)
- Major bleeding: similar between groups – IRR 0.83 (0.48 – 1.43)
Interestingly, in a small subgroup, combining DOACs + a single antiplatelet agent seemed to mitigate arterial risk — a hypothesis that calls for future trials.
Clinical Message
Despite their convenience, DOACs may not be safe in high-risk APS, especially in patients with arterial events or triple-positive profiles.
Warfarin remains the gold standard.
The findings emphasize the need for precision anticoagulation strategies and better biomarkers to guide therapy in APS.
This meta-analysis reinforces the critical message: not all thromboses are the same, and not all anticoagulants are interchangeable.”
Title: Direct oral anticoagulants versus Vitamin K antagonists in antiphospholipid syndrome: A systematic review and meta-analysis
Authors: Alessandra Ida Celia, Giovanni Maria Vescovo, Gianmarco Sarto, Cristiano Alessandri, Antonio Iaconelli, Domenico D’Amario, Giacomo Frati, Fabrizio Conti, Sebastiano Sciarretta, Dominick J. Angiolillo, Andrea Fava, Michelle A. Petri, Behnood Bikdeli, Mattia Galli
Read the full article.
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