{"id":175543,"date":"2020-01-16T00:00:00","date_gmt":"2020-01-15T23:00:00","guid":{"rendered":"https:\/\/www.bcfi.be\/mise-en-garde-contre-lusage-daod-chez-les-patients-atteints-du-syndrome-des-antiphospholipides\/"},"modified":"2026-04-02T19:09:32","modified_gmt":"2026-04-02T17:09:32","slug":"mise-en-garde-contre-lusage-daod-chez-les-patients-atteints-du-syndrome-des-antiphospholipides","status":"publish","type":"post","link":"https:\/\/h.cbip.be\/fr\/mise-en-garde-contre-lusage-daod-chez-les-patients-atteints-du-syndrome-des-antiphospholipides\/","title":{"rendered":"Mise en garde contre l\u2019usage d\u2019AOD chez les patients atteints du syndrome des antiphospholipides"},"content":{"rendered":"<p>Les donn&eacute;es de deux RCT<span class='folia-referentie-note'>1&#x002C;2<\/span> et d&rsquo;une m&eacute;ta-analyse portant essentiellement sur des &eacute;tudes observationnelles<span class='folia-referentie-note'>3<\/span> sugg&egrave;rent que les anticoagulants oraux directs (AOD) ne sont pas efficaces chez certains patients atteints du syndrome des antiphospholipides (SAPL). Chez les patients atteints du SAPL&#x002C; le traitement par AOD a en effet &eacute;t&eacute; associ&eacute; &agrave; un plus grand nombre de thromboses (plus sp&eacute;cifiquement art&eacute;rielles)&#x002C; par rapport aux patients trait&eacute;s par des antagonistes de la vitamine K. L&rsquo;Agence europ&eacute;enne des m&eacute;dicaments (EMA) a d&eacute;cid&eacute; qu&rsquo;une mise en garde doit figurer dans le RCP de chaque AOD&#x002C; signalant que leur usage n&rsquo;est pas recommand&eacute; chez les patients atteints du syndrome des antiphospholipides<span class='folia-referentie-note'>4<\/span>.<br \/> Il n&#39;est pas possible de proc&eacute;der &agrave; un d&eacute;pistage pr&eacute;alable du SAPL chez chaque patient &eacute;ligible pour un traitement par AOD&#x002C; vu que le diagnostic d&eacute;finitif du SAPL n&eacute;cessite au moins deux prises de sang &agrave; un intervalle d&#39;au moins 12 semaines. L&rsquo;instauration du traitement anticoagulant ne peut pas &ecirc;tre report&eacute; jusqu&rsquo;&agrave; confirmation du diagnostic &eacute;ventuel de SAPL. Il semble donc judicieux d&rsquo;&eacute;viter les AOD chez les patients d&eacute;butant un traitement anticoagulant et chez lesquels un SAPL est suspect&eacute;.<\/p>\n<div class='detailed-content'>Le d&eacute;pistage du SAPL semble le plus pertinent chez les patients suivants<span class='folia-referentie-note'>5<\/span>: <\/p>\n<ul>\n<li>Patients &acirc;g&eacute;s de moins de 50 ans pr&eacute;sentant une thrombose art&eacute;rielle ou veineuse inexpliqu&eacute;e.<\/li>\n<li>Patients pr&eacute;sentant une thrombose de localisation inhabituelle.<\/li>\n<li>Patientes pr&eacute;sentant une fausse couche tardive (&agrave; 12-24 semaines de grossesse).<\/li>\n<li>Patients ayant une maladie auto-immune syst&eacute;mique (lupus &eacute;ryth&eacute;mateux syst&eacute;mique&#x002C; polyarthrite rhumato&iuml;de&#x002C; thrombocytop&eacute;nie auto-immune&#x002C; an&eacute;mie h&eacute;molytique auto-immune) et pr&eacute;sentant une thrombose ou une complication li&eacute;e &agrave; la grossesse.<\/li>\n<\/ul><\/div>\n<h2>Sources sp&eacute;cifiques<\/h2>\n<p class='reference'><span class='folia-referentie-tekst'><span class='folia-referentie-nummer'>1<\/span> Pengo V&#x002C; Denas G&#x002C; Zoppellaro G&#x002C; Jose SP&#x002C; Hoxha A et al. Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood 2018; 132:1365-71. doi: <a href='https:\/\/ashpublications.org\/blood\/article\/132\/13\/1365\/105711\/Rivaroxaban-vs-warfarin-in-highrisk-patients-with'>10.1182\/blood-2018-04-848333<\/a><\/span><br \/> <span class='folia-referentie-tekst'><span class='folia-referentie-nummer'>2<\/span> Ordi-Ros J&#x002C; S&aacute;ez-Comet L&#x002C; P&eacute;rez-Conesa M&#x002C; Vidal X&#x002C; Riera-Mastra A et al. Rivaroxabna versus viramin K antagonist in antiphospholipid syndrome. A randomized noninferiority trial. Ann Intern Med 2019;171:685-94. doi: <a href='https:\/\/annals.org\/aim\/article-abstract\/2753019\/rivaroxaban-versus-vitamin-k-antagonist-antiphospholipid-syndrome-randomized-noninferiority-trial'>10.7326\/M19-0291<\/a><br \/> <span class='folia-referentie-nummer'>3<\/span> Dufrost V&#x002C; Risse J&#x002C; Reshetnyak T&#x002C; Satybaldyeva M&#x002C; Du Y et al. Increased risk of thrombosis in antiphospholipid patients treated with direct anticoagulants. Results from an international patient-level data meta-analysis. Autoimmun Rev 2018; 17:1011-21. doi: <a href='https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S1568997218301836?via%3Dihub'>10.1016\/j.autrev.2018.04.009<\/a><br \/> <span class='folia-referentie-nummer'>4<\/span> European Medicines Agency. Pharmacovigilance Assessment Committee (PRAC). PRAC recommendations on signals. Adopted at the 8-11 April 2019 PRAC meeting. Via: <a href='https:\/\/www.ema.europa.eu\/en\/documents\/prac-recommendation\/prac-recommendations-signals-adopted-8-11-april-2019-prac-meeting_en.pdf'>https:\/\/www.ema.europa.eu\/en\/documents\/prac-recommendation\/prac-recommendations-signals-adopted-8-11-april-2019-prac-meeting_en.pdf<\/a><br \/> <font color='#52a800'><b>5<\/b><\/font> Rand JH&#x002C; Wolgast LR. Dos and don&rsquo;ts in diagnosing antiphospholipis syndrome. Hematology Am Soc Hematol Educ Program 2012;455-9. <a href='https:\/\/doi.org\/10.1182\/asheducation-2012.1.455'>doi: 10.1182\/asheducation-2012.1.455<\/a><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Les donn&eacute;es de deux RCT1&#x002C;2 et d&rsquo;une m&eacute;ta-analyse portant essentiellement  [&#8230;]<\/p>\n","protected":false},"author":9,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12,61],"tags":[20213,20224],"class_list":["post-175543","post","type-post","status-publish","format-standard","hentry","category-actualites","category-2020-fr","tag-import_tags","tag-import_tags-nl"],"_links":{"self":[{"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/posts\/175543","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/comments?post=175543"}],"version-history":[{"count":1,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/posts\/175543\/revisions"}],"predecessor-version":[{"id":178127,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/posts\/175543\/revisions\/178127"}],"wp:attachment":[{"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/media?parent=175543"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/categories?post=175543"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/h.cbip.be\/fr\/wp-json\/wp\/v2\/tags?post=175543"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}