Anti-phospholipid syndrome comprises a broad spectrum of manifestations with thrombotic events as a serious issue. The current mainstay of treatment for thrombotic anti-phospholipid syndrome is heparin followed by long-term anticoagulation with vitamin K antagonists. Vitamin K antagonists’ management in this group of patients is frequently cumbersome, requires close monitoring and may affect patient’s quality of life. There is also a high recurrence rate in high risk patients. The introduction of the oral direct inhibitors of coagulation for the management for thromboembolism is currently established for several indications. These agents are fixed dose with predictable anticoagulant effect and do not interact with dietary constituents and have few drug interactions.