Current guidance [13,20,21], however, in accordance with recommendations issued by the European Medicines Agency [22] and adopted by regulatory agencies worldwide, cautions against use of DOACs in APS patients with arterial thrombosis and/or triple-aPL positivity (concurrent presence of the 3 criteria aPL: LA, IgG and/or IgM aCL, and aβ2GP1). This evidence concerns the gene CD40LG and autoimmune polyendocrinopathy.