Pengo V, et al. - In this randomized, open-label, multicenter, non-inferiority study with blinded end-point adjudication, researchers compared rivaroxaban to warfarin with respect to efficacy and safety in high-risk patients with thrombotic antiphospholipid syndrome. They compared thromboembolic events, major bleeding and vascular death among patients who received rivaroxaban 20 mg once daily (15 mg once daily based on kidney function) vs those who received warfarin (INR target 2.5). This study included only high-risk patients triple positive for lupus anticoagulant, anti-cardiolipin and anti-β2-glycoprotein I antibodies of the same isotype (triple-positivity). They observed treatment with rivaroxaban vs warfarin was associated with an increased rate of events, thus demonstrating no benefit and excess risk.