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Antiphospholipid Syndrome — RACP Adult Medicine MCQ

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HardRheumatologyAntiphospholipid SyndromeRACP Adult Medicine

A 35-year-old woman with SLE and antiphospholipid syndrome (triple-positive: lupus anticoagulant, anti-cardiolipin, anti-β2GPI) presents with her second DVT. She is on warfarin with target INR 2.0–3.0. What is the most appropriate long-term management?

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Correct answer: C — Warfarin INR 2.0–3.0 lifelong

Triple-positive APS with recurrent VTE requires lifelong warfarin with INR 2.0–3.0. DOACs are NOT recommended in APS, particularly triple-positive APS, following the TRAPS trial (rivaroxaban was inferior to warfarin with increased thrombotic events). Higher-intensity warfarin (INR 3.0–4.0) may be considered for arterial thrombosis.

Reference: EULAR – 2019 – APS Guidelines; 14th International Congress on APS 2023 Update