Comparing APLS and oranges: caution with the use of direct-acting oral anticoagulants (DOACs) instead of warfarin in the treatment of antiphospholipid syndrome (APLS).

A 63-year-old woman with known antiphospholipid syndrome (APLS) presented with catastrophic APLS and multiorgan dysfunction after a change in her anticoagulation from warfarin to rivaroxaban. Evidence suggests direct-acting oral anticoagulants (DOACs) like rivaroxaban may be less effective than warfarin in secondary prevention of thrombotic events in high-risk APLS patients.