1. Use of new oral anticoagulants in retinal trombosis and ischemic optic neuritis secondary to Anti Phospholipid Syndrome (APS).
Patricia Fanlo Mateo1, Henar Heras Mulero2, Mariano León Rosique1, Esther Compains Silva2
Internal Medicine Department 1 .Ophtalmology department 2.
Multidisciplinary Uveitis Unit .
Complejo Hospitalario de Navarra . Pamplona. Spain  
OBJETIVE
To describe 2 patients with retinal trombosis and ischemic optic neuritis due to APS that we treat with rivaroxaban because of failure of vitamina K antagonist and rethrombosis .

2. Case 1
46 years old woman with a history of C1 inhibitor deficiency and maintained positivity for lupus anticoagulant and occasionally B1 glycoprotein antibody positivity. She was diagnosed of left anterior ischemic neuritis in an advanced stage in July weeks after, antiphospholipid antibodies persisted positive. We started anticoagulation with enoxaparin but in November 2013 it was stopped for allergy. We changed to acenocumarol. In February 2015 acenocumarol was discontinued because irregular anticoagulant control (TRT 25). We started rivaroxaban 20 mg daily.

3. OCT normal right eye .

4. OCT : sectorial nasal atrophic in left eye

5. Case 2
37 year old woman sufferred an episode of retinal arterial thrombosis in left eye in January 2012.
Lupic anticoagulant and antiglycoprotein 1 antibody were positive and persisted positive after 12 weeks.
We started treatment with acenocumarol.
In November 2014 he has a second episode of left retinal arterial thrombosis because of a poor control of anticoagulation (INR. 1.5, 47.2 TRT). We decided to initiate rivaroxaban 20 mg daily.

6. 13/1/2012

7. 13/1/2012

8. 23/2/2015

9. Results
Nowadays long term anticoagulation is the current treatment of thrombotic events in APS. The treatment of choice is vitamin K antagonist such as acenocumarol or warfarin but these agents have limitations due to hemorrhagic effects and interactions. New oral anticoagulants (NOAC) have been approved for non valvular atrial fibrillation and deep vein trombosis.

10. Results
In a recent study rivaroxaban demostrates that the anticoagulant effect is not
inferior to that of warfarin and absence of any adverse effects.
we decided to change the treatment with acenocumarol to rivaroxaban
in our patients due to the bad control of international
normalized ratio and the recurrent thombotic event in one case.  

11. Conclusion
Although rivaroxaban is not approved to the treatment of thrombosis in APS could be an alternative for retinal thrombosis and ischemic optic neuritis in APS.