Introduction: Antiphospholipid syndrome (APS) is one of the most common causes of acquired thrombophilia and it is an autoimmune multisystem disorder characterized by arterial, venous, or small vessel thromboembolic events and/or pregnancy morbidity in the presence of persistent antiphospholipid antibodies (aPL). Indefinite anticoagulation with vitamin-K antagonists (VKAs) is considered the current secondary thrombophylaxis. Nevertheless, there are a high number of relapses due mainly to aPL interaction with the prothrombin time assay. For this reason, there are a high number of recurrences, which can put patient’s life in risk. Actually, scientific community is waiting for the results of powered studies regarding the use of DOACs in APS.
Case Presentation: we report a case of a patient with APS and hereditary thrombophilia treated with apixaban, a direct factor Xa inhibitor and after twelve months switched to rivaroxaban.
Conclusion: even if the use of non-vitamin-K oral anticoagulants is considered off label in APS patients, DOACs can be an effective treatment in APS patients with relapse of venous or arterial thromboembolism. In addition, if the patient, as in our case, ha also a hereditary thrombophilia, an available alternative is needed and this can be represented by direct factor Xa inhibitors.

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