I read with interest the meta-analysis by Pau Cerdà et al. on direct oral anticoagulants compared to vitamin K antagonists in antiphospholipid syndrome (APS) [1]. Overall, I agree with the Authors’ conclusions that the use of rivaroxaban in APS patients is associated with an increase rate of recurrences, at least in those with an arterial index event or triple positivity for antiphospholipid (aPL) antibodies. However, the statement that rivaroxaban and VKAs are equally effective in preventing venous thromboembolism must be taken with caution.
