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2015 ; 24
(10
): 1087-94
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Rivaroxaban in antiphospholipid syndrome (RAPS) protocol: a prospective,
randomized controlled phase II/III clinical trial of rivaroxaban versus warfarin
in patients with thrombotic antiphospholipid syndrome, with or without SLE
#MMPMID25940537
Cohen H
; Doré CJ
; Clawson S
; Hunt BJ
; Isenberg D
; Khamashta M
; Muirhead N
Lupus
2015[Sep]; 24
(10
): 1087-94
PMID25940537
show ga
INTRODUCTION: The current mainstay of the treatment of thrombotic
antiphospholipid syndrome (APS) is long-term anticoagulation with vitamin K
antagonists (VKAs) such as warfarin. Non-VKA oral anticoagulants (NOACs), which
include rivaroxaban, have been shown to be effective and safe compared with
warfarin for the treatment of venous thromboembolism (VTE) in major phase III
prospective, randomized controlled trials (RCTs), but the results may not be
directly generalizable to patients with APS. AIMS: The primary aim is to
demonstrate, in patients with APS and previous VTE, with or without systemic
lupus erythematosus (SLE), that the intensity of anticoagulation achieved with
rivaroxaban is not inferior to that of warfarin. Secondary aims are to compare
rates of recurrent thrombosis, bleeding and the quality of life in patients on
rivaroxaban with those on warfarin. METHODS: Rivaroxaban in antiphospholipid
syndrome (RAPS) is a phase II/III prospective non-inferiority RCT in which
eligible patients with APS, with or without SLE, who are on warfarin, target
international normalized ratio (INR) 2.5 for previous VTE, will be randomized
either to continue warfarin (standard of care) or to switch to rivaroxaban.
Intensity of anticoagulation will be assessed using thrombin generation (TG)
testing, with the primary outcome the percentage change in endogenous thrombin
potential (ETP) from randomization to day 42. Other TG parameters, markers of in
vivo coagulation activation, prothrombin fragment 1.2, thrombin antithrombin
complex and D-dimer, will also be assessed. DISCUSSION: If RAPS demonstrates i)
that the anticoagulant effect of rivaroxaban is not inferior to that of warfarin
and ii) the absence of any adverse effects that cause concern with regard to the
use of rivaroxaban, this would provide sufficient supporting evidence to make
rivaroxaban a standard of care for the treatment of APS patients with previous
VTE, requiring a target INR of 2.5.