This retrospective single‑center study evaluated the efficacy and safety of direct oral anticoagulants (DOAC) compared with warfarin for treatment of pulmonary thromboembolism (PTE) in patients with non‑triple‑positive antiphospholipid syndrome (APS). Patients were identified at The First Affiliated Hospital of Chongqing Medical University between July 2016 and July 2021 and had to meet the Sapporo diagnostic criteria for APS.
A total of 43 APS patients with confirmed PTE were included and divided by maintenance oral anticoagulant into a DOAC group (n = 34) and a warfarin group (n = 9). The DOAC group comprised 19 males and 16 females with a mean age of 57.0 ± 17.7 years. The warfarin group included 3 males and 6 females with a mean age of 37.7 ± 15.0 years. Except for age, baseline characteristics and laboratory findings showed no statistically significant differences between the two groups according to the abstract.
All patients met the Sapporo criteria for APS and had a definitive diagnosis of PTE. The abstract does not specify which DOAC agents were used, their doses, the duration of anticoagulation, or warfarin management parameters such as time in therapeutic range. Those specifics were not reported in the source abstract.
During follow‑up, recurrence of venous thromboembolism (VTE) occurred in 2 of 34 patients (5.9%) in the DOAC group and in 0 of 9 patients in the warfarin group. The difference in VTE recurrence between groups was not statistically significant (P = 1.000). No deaths were reported in either group during follow‑up, and there was no statistically significant difference in mortality.
Anticoagulation‑related bleeding events were observed in 4 of 34 patients (11.8%) in the DOAC group and 3 of 9 patients in the warfarin group. The reported risk ratio for bleeding was 0.353 with a 95% confidence interval of 0.096 to 1.301; this comparison did not reach statistical significance (P = 0.147).
Key reported p values and estimates from the abstract:
These results indicate no statistically significant differences in recurrence, mortality, or bleeding between the DOAC and warfarin groups in this cohort. The authors interpret these findings as suggesting potential non‑inferiority of DOAC compared with warfarin for non‑triple‑positive APS‑related PTE in this retrospective sample.
The authors conclude that DOAC may be non‑inferior to warfarin in both efficacy and safety for treating non‑triple‑positive APS associated with PTE, based on the observed rates of VTE recurrence, bleeding, and absence of deaths in both groups. The abstract presents these findings as preliminary observational evidence from a single center.
The abstract lacks several details that are relevant for interpreting the findings:
Because these details were not reported in the source abstract, they should be confirmed by consulting the full text before applying findings to clinical practice.
The authors declared no competing interests. The article is published in Zhonghua Jie He He Hu Xi Za Zhi (Chinese) with an English abstract. PubMed PMID is 42706207 and DOI 10.3760/cma.j.cn112147-20251214-00789.
Clinicians should interpret these retrospective, single‑center results cautiously and consider full‑text review or additional studies for more complete data on agent‑specific outcomes, dosing, follow‑up duration, and anticoagulation management details.