Management of Lupus Patients on Apixaban

Rationale for Continuing Apixaban in Lupus Patients

In patients with SLE and antiphospholipid syndrome (APS), long-term anticoagulation is effective for secondary prevention of thrombosis, according to the European League Against Rheumatism, 1
The American College of Rheumatology recommends that lupus patients with antiphospholipid antibodies have increased risk of thrombotic events and may benefit from continued anticoagulation, 4, 5

The European League Against Rheumatism suggests that hydroxychloroquine should be maintained as the cornerstone of SLE treatment for all lupus patients, including those on anticoagulation, as it reduces disease flares and has protective effects against thrombosis, 3
Estrogen-containing medications increase the risk of thrombosis in lupus patients with antiphospholipid antibodies and should be used with caution, according to the American College of Rheumatology, 1, 2

A recent randomized trial comparing rivaroxaban to warfarin in APS with triple antibody positivity was prematurely terminated due to excess thromboembolic events in the DOAC arm, as reported by the European League Against Rheumatism, 4, 5
While specific studies on apixaban in lupus-associated APS are limited, caution should be exercised when using DOACs in patients with triple-positive antiphospholipid syndrome, according to the American College of Rheumatology, 4, 5

In pregnant patients with SLE and antiphospholipid syndrome, combined unfractionated or low molecular weight heparin and aspirin are recommended instead of apixaban, according to the European League Against Rheumatism, 1
Apixaban should be discontinued and switched to appropriate pregnancy-compatible anticoagulation if pregnancy is planned or confirmed, as recommended by the American College of Rheumatology, 1, 2