DOAC Versus VKA in Patients With Non-high-risk APS : Prospective Cohort Study

prospective cohort of APS patient treated with VKA or DOACs (specially oral Xa treatment).

APS patients will be non high risk patients (no triple positivity, any previous arterial or small vessels thrombosis or cardiac involvment).

the treatment taken by the patient at inclusion will not be modified. There will therefore be no change to the patient's usual management.

all patients will have a blood sample taken at inclusion as part of a routine blood test.

Patients will be prospectively follow up and the level of recurrence thrombotic event will be recorded

Inclusion criteria

• Persons who have received full information about the organization of the research and have given their oral consent to participate.
• Male or female 18 years of age or older;
• Carrier of venous thrombotic SAPL:

• Not favoured by a major or ≥ 2 minor favouring factors, if the patient doesn't present with obstetrical SAPL in accordance with the ACR/EULAR 2023 clinical classification criteria.
• Or favored by ≥ 2 minors, if the patient has obstetrical SAPL: severe preeclampsia < 34 weeks or placental insufficiency
• Regardless of how long the disease has been present
• With persistent positivity of at least one biological criterion:

• Positivity of circulating lupus anticoagulant or IgG anticardiolipid or IgG anti-beta-2GPI
• And persistence of the same positive test ≥ 12 weeks apart
• And With maximum delay of positivity of the 1st antiphospholipid test of 3 years after the thrombotic event
• Current anticoagulant treatment, regardless of date of introduction

• rivaroxaban or apixaban
• or antivitamin K
• Patient affiliated to a social security system

Exclusion criteria

• Venous thrombotic event motivating current anticoagulant treatment favoured by a major favouring factor:

• Active cancer
• Hospitalization with bed rest for at least 3 days in the 3 months preceding the event
• Major trauma with fractures or spinal cord injury in the month preceding the event
• Surgery with general/spinal/epidural anesthesia for > 30 minutes in the 3 months preceding the event.
• In the absence of a history of pre-eclampsia or placental insufficiency: venous thrombotic event motivating current anticoagulant treatment favoured by 2 or more minor favouring factors:

• Systemic autoimmune disease or active inflammatory bowel disease
• Acute/severe infection
• Central venous catheter in the same vascular bed
• Hormone replacement therapy, estrogenic oral contraceptives, or hormone-stimulating therapy in progress
• Long-distance travel (≥ 8 hours)
• Obesity (BMI ≥ 30 kg/m²)
• Pregnancy or post-partum (6 weeks after delivery)
• Prolonged immobilization
• Surgery with general/spinal/epidural anesthesia for < 30 minutes in the 3 months preceding the event
• Known triple antiphospholipid positivity
• Isolated IgM antiphospholipid positivity
• History of known arterial thrombosis
• History of known microcirculatory thrombosis
• Known SAPL-related cardiac valvular disease
• Persons referred to in articles L. 1121-5, L. 1121-7 and L1121-8 of the Public Health Code
• Persons deprived of their liberty by judicial or administrative decision, persons under psychiatric care under articles L. 3212-1 and L. 3213-1.
• Glomerular filtration rate < 30ml/min.
• Weight < 50kg
• History of thrombotic recurrence under well-administered anticoagulant therapy.