1. Browse Program
2. Posters/Exhibits/Break
3. Posters/Exhibits/Break
4. Presentation

Presentation Details

Anticoagulation Practices in Antiphospholipid Syndrome: A Retrospective Chart Review Anthony Liang, Adam Cuker, Pardis Niami. Hospital of the University of Pennsylvania, Philadelphia, PA, USA

Abstract

Title: Anticoagulation Practices in Thrombotic Antiphospholipid Syndrome: A retrospective chart review    Authors: Anthony Liang, PharmD; Adam Cuker, MD, MS; Pardis Niami, PharmD, CACP  Background  Warfarin remains the mainstay of therapy for patients with thrombotic antiphospholipid syndrome (APS) to prevent recurrent thromboembolic events. Although direct oral anticoagulants (DOACs) are attractive in many settings due to their predictable pharmacokinetics and lack of routine monitoring, they are not recommended for APS. Multiple studies have demonstrated an increased risk of thrombotic events with DOAC use in this population. Notably, the TRAPS trial, which compared rivaroxaban to warfarin in triple-positive APS patients, was terminated early due to excess thrombotic events in the rivaroxaban group. Similarly, the ASTRO-APS trial, comparing apixaban to warfarin, was halted early because of a high rate of thrombotic stroke in the apixaban arm. Multiple meta-analyses have further confirmed worse outcomes of increased thrombotic events with DOAC use in APS patients. Reflecting this evidence, the American Heart Association/American Stroke Association stroke guidelines and CHEST venous thromboembolism guidelines recommend against the use of DOACs.  Objectives  The purpose of this study is to evaluate the quality of current anticoagulation management practices for patients with thrombotic antiphospholipid syndrome (TAPS), with a focus on the choice of anticoagulant. Secondary analyses will further characterize management practices within the DOAC group and the warfarin subgroup. Given that DOACs are not recommended for TAPS, the presence of provider documentation on discussion with patients on DOAC inferiority will be evaluated. For patients on warfarin, the recommended target INR is 2.0–3.0; however, higher INR targets are sometimes used in clinical practice. This study will evaluate INR goals among warfarin-treated patients and describe any documented rationale for selecting higher targets (upper limit >3).  Methods  This study is a retrospective, single-center, cohort study conducted at the University of Pennsylvania Health System (UPHS) of adult patients 18 years or older diagnosed with thrombotic antiphospholipid syndrome treated with anticoagulation. This study will target goal of 250 patients. The primary endpoint is the difference in prevalence of patients on warfarin, LMWH, or fondaparinux, and DOACs. The secondary endpoints will depend based on whether patients on warfarin or DOACs. In the warfarin subgroup, the secondary endpoint will be the prevalence of INR goals 2.0-3.0 and INR goals with upper ranges >3.0. For those with INR goals >3.0, we will be describing the documented rationale for higher INR goals. With the DOAC group, the secondary endpoint will be the prevalence of (or lack thereof) documented provider discussion with patients about DOAC inferiority. All baseline characteristics collected for both groups will be analyzed using descriptive statistics to identify any differences between groups. Comparisons between groups (DOAC vs. warfarin/LMWH/fondaparinux) will be performed using the chi-square test or Fisher’s exact test, as appropriate, for categorical variables. Differences in patient characteristics between these groups will be assessed using chi-square tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables, as appropriate.  Results  Research in Progress  Conclusion  Research in Progress  

No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.