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APS Stroke in SLE — RACP Adult Medicine MCQ

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ModerateHaematologyAPS Stroke in SLERACP Adult Medicine

A 30-year-old woman with SLE and known antiphospholipid syndrome (triple positive) presents with sudden onset of severe headache and left hemiparesis. CT brain shows right MCA territory infarct. She is on warfarin with a subtherapeutic INR of 1.4. What is the most likely haematological complication?

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Correct answer: A — Antiphospholipid syndrome

Arterial thrombosis (stroke) in a patient with known triple-positive APS on subtherapeutic warfarin. APS is the most common cause of acquired thrombophilia in SLE. Subtherapeutic INR allowed thrombosis. Management is therapeutic anticoagulation with warfarin (target INR 2.0–3.0 or higher). DOACs are contraindicated in triple-positive APS.

Reference: EULAR – 2019 – APS Guidelines; Stroke Foundation 2024