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Antiphospholipid Syndrome — RACP Adult Medicine MCQ

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HardRheumatologyAntiphospholipid SyndromeRACP Adult Medicine

A 38-year-old woman with SLE develops acute pleuritic chest pain and dyspnoea. Her aPTT is prolonged and does not correct with mixing studies. She has a history of two previous miscarriages. Anti-cardiolipin antibodies and lupus anticoagulant are positive. CTPA confirms bilateral pulmonary emboli. What is the recommended long-term anticoagulant?

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Correct answer: A — Warfarin

In antiphospholipid syndrome (APS) with VTE, warfarin (target INR 2.0–3.0) remains the preferred long-term anticoagulant. The TRAPS and ASTRO-APS trials showed higher rates of thrombotic events with rivaroxaban compared to warfarin in APS patients, particularly those who are triple-positive (lupus anticoagulant + anti-cardiolipin + anti-beta-2 glycoprotein I). DOACs are NOT recommended for APS.

Reference: eTG – 2025 – Rheumatology; ISTH – 2020 – APS Anticoagulation Guidance