Recurrent VTE in APS — RACP Adult Medicine MCQ

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HardHaematologyRecurrent VTE in APSRACP Adult Medicine

A 55-year-old woman with known antiphospholipid syndrome (triple positive) on warfarin develops a new DVT while her INR is therapeutic at 2.5. How should her anticoagulation be managed?

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Correct answer: C — Increase INR target to 3.0–4.0

For recurrent thrombosis while on therapeutic warfarin (INR 2.0–3.0) in APS, options include intensifying anticoagulation by increasing the INR target to 3.0–4.0. DOACs are NOT recommended for triple-positive APS (TRAPS trial showed increased thrombotic events). Adding aspirin or hydroxychloroquine (which has antithrombotic properties) may be considered. Some experts recommend adding LMWH. This represents a challenging clinical scenario requiring specialist input.

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