vitamin-k-semiquinone-radical and Catastrophic-Illness

: Vitamin K antagonists (VKA) remain the treatment of choice for catastrophic antiphosphilipid syndrome (CAPS). However, when VKAs do not work for a specific patient, direct oral anticoagulants (DOAC) may be a valid therapeutic alternative. We present a patient with a psychiatric disorder and CAPS who was noncompliant to VKA and low-molecular-weight heparin. He was started on dabigatran and has remained thrombosis-free for 8 years. Due to CAPS he has developed progressive renal failure but dabigatran levels were within the expected range. In conclusion, this case report provides anecdotic evidence that dabigatran may be of use in patients with high-risk APS in whom VKA are not an option.

Topics: Anticoagulants; Antiphospholipid Syndrome; Catastrophic Illness; Dabigatran; Factor Xa Inhibitors; Humans; Male; Treatment Outcome; Vitamin K

Antiphospholipid syndrome associate thromboembolic events (arterial or venous), and presence of antiphospholipid antibodies, and require anticoagulation. A catastrophic variant may develop, resulting in multiorgan failure, with high mortality rate. This article presented a patient with antiphospholipid syndrome presenting a catastrophic antiphospholipide syndrome after anticoagulation suspending for gastrointestinal bleeding. Multidisciplinary management in intensive care unit and aggressive therapies (corticosteroids, anticoagulation, plasma exchange) were essential to rescue the patient.

Topics: Anemia; Anticoagulants; Antiphospholipid Syndrome; Biopsy; Catastrophic Illness; Gastrointestinal Hemorrhage; Hemoglobins; Hemostatics; Heparin; Humans; Male; Middle Aged; Platelet Count; Respiratory Insufficiency; Vitamin K