Thromb Haemost 2014; 112(05): 947-950
DOI: 10.1160/th14-03-0272
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Failure of dabigatran and rivaroxaban to prevent thromboembolism in antiphospholipid syndrome: a case series of three patients

Jordan K. Schaefer
1   Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Robert D. McBane
2   Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
David F. Black
3   Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
Lindsy N. Williams
4   Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
Kevin G. Moder
5   Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
Waldemar E. Wysokinski
2   Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
› Author Affiliations
Further Information

Publication History

Received: 26 March 2014

Accepted after major revision: 30 May 2014

Publication Date:
20 November 2017 (online)


Direct oral factor inhibitors (DOFIs) are an attractive alternative to vitamin K antagonists (VKA) for the treatment of patients with antiphospholipid syndrome (APS). In the absence of prospective, randomised trial data, reports of therapeutic failures in clinical practice alert clinicians to potential limitations of DOFI therapy for this indication. Data for all cases were collected from a centralised system that contains complete medical records of all patients treated and followed at Mayo Medical Center. We present here three consecutive APS patients who had had no thromboembolism recurrence on warfarin but were switched to DOFIs. The diagnosis of APS was established according to currently recommended criteria. The three cases were as follows: A woman with primary APS developed thrombotic endocarditis with symptomatic cerebral emboli after transition to dabigatran. A second woman with primary APS experienced ischemic arterial strokes and right transverse-sigmoid sinus thrombosis after conversion to rivaroxaban. A man with secondary APS suffered porto-mesenteric venous thrombosis after switching to rivaroxaban. None of these patients had failed warfarin prior to the transition to DOFIs. Based on these three cases, we advocate caution in using DOFIs for APS patients outside of a clinical trial setting, until further data becomes available.