Recurrent venous thromboembolism after discontinuation of rivaroxaban therapy in a patient with antiphospholipid syndrome

A Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by thrombembolic events including thromboembolism (VTE) in association with the presence of antiphospholipid antibodies. The standard treatment of VTE historically consists of anticoagulation therapy with warfarin, a vitamin K antagonist. Recently, direct oral anticoagulants, including rivaroxaban have become available for the treatment of VTE. However, the choice of anticoagulant, and the duration of anticoagulation in patients with APS has not been determined yet due to lack of evidence. Here, we report a case of recurrent venous thrombosis after discontinuation of rivaroxaban therapy and avoiding sedentary life style in a patient with APS. We suggest that indefinite anticoagulation therapy might be needed even in low risk APS cases.

This article has been accepted for publication in BMJ Case Reports, 2019 following peer review, and the Version of Record can be accessed online at https://doi.org/10.1136/bcr-2018-227663.