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Triple-Positive APS — RACP Adult Medicine MCQ

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HardHaematologyTriple-Positive APSRACP Adult Medicine

A 35-year-old woman with recurrent pregnancy losses (3 consecutive first-trimester miscarriages) is tested for antiphospholipid syndrome. Lupus anticoagulant is positive on two occasions 12 weeks apart. Anticardiolipin IgG is >80 GPL (high titre). Anti-β2-glycoprotein I IgG is positive. She has no prior thrombosis. What is the risk profile?

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Correct answer: B — High risk — triple positive antiphospholipid antibodies

Triple-positive APS (all three: lupus anticoagulant + anticardiolipin + anti-β2GPI, confirmed ≥12 weeks apart) is the highest-risk antibody profile. Triple positivity has the strongest association with both thrombosis and pregnancy morbidity. Management of obstetric APS with triple positivity: aspirin 100 mg from pre-conception + prophylactic-dose LMWH from positive pregnancy test throughout pregnancy and 6 weeks postpartum. Despite no prior thrombosis, long-term primary thromboprophylaxis with aspirin is recommended.

Reference: EULAR – 2019 – APS; eTG Haematology 2024