Antiphospholipid Syndrome – Anticoagulation — SCE Neurology MCQ

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HardCerebrovascular DiseaseAntiphospholipid Syndrome – AnticoagulationSCE Neurology

A 35-year-old woman with recurrent strokes and miscarriages has positive anticardiolipin antibodies and lupus anticoagulant. What is the recommended long-term anticoagulant?

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Correct answer: E — Warfarin with target INR 2.5

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · C = shown as D · B = shown as E

In antiphospholipid syndrome with arterial thrombosis, warfarin is the recommended long-term anticoagulant. DOACs are NOT recommended — the TRAPS trial showed increased thrombotic events with rivaroxaban compared to warfarin in triple-positive APS. A: Aspirin alone is insufficient for APS with arterial thrombosis. C/D/E: DOACs are inferior to warfarin in APS.

Reference: EULAR/ACR APS Guidelines (2019); TRAPS Trial (2018)