skip to main content

Refractory APS Renal Artery Thrombosis — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

HardAcute Kidney InjuryRefractory APS Renal Artery ThrombosisESENeph

A 45-year-old woman with antiphospholipid syndrome develops renal artery thrombosis causing AKI. She is on therapeutic Warfarin (INR 2.8). What does this indicate about her disease severity?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Recurrent arterial thrombosis despite therapeutic anticoagulation

Arterial thrombosis despite therapeutic anticoagulation in APS suggests refractory disease. Options include: (1) increasing INR target to 3.0-4.0 (higher bleeding risk); (2) adding low-dose aspirin; (3) switching to LMWH (though long-term practicality is limited). DOACs are generally NOT recommended for APS (particularly triple-positive APS – the TRAPS trial showed worse outcomes with Rivaroxaban vs Warfarin). Hydroxychloroquine has antithrombotic properties and may be added. This scenario also warrants screening for catastrophic APS risk.

Reference: https://guidelines.ukkidney.org