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APS with Arterial Thrombosis — RACP Adult Medicine MCQ

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HardRheumatologyAPS with Arterial ThrombosisRACP Adult Medicine

A 42-year-old man with APS presents with an acute ischaemic stroke. He has prior DVT and is triple-positive. He was previously non-adherent with warfarin. What is the most appropriate long-term antithrombotic strategy after acute treatment?

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Correct answer: D — Warfarin INR 3.0–4.0 lifelong

APS with both venous and arterial thrombosis (stroke) that is triple-positive may warrant higher-intensity anticoagulation (INR 3.0–4.0) per expert consensus, although evidence is limited. This is a strong indication for lifelong anticoagulation. DOACs are contraindicated in triple-positive APS. Patient education about adherence is critical.

Reference: EULAR – 2019 – APS Guidelines; BSR 2024 APS Update