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Obstetric APS — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicineObstetric APSRACP Adult Medicine

A 35-year-old woman presents with fatigue, arthralgia, and recurrent miscarriages. She has livedo reticularis on her legs. aPTT is prolonged and does not correct on mixing study. Anti-cardiolipin IgG antibodies are strongly positive on two occasions 14 weeks apart. She has never had a thrombotic event. What is the recommended prophylactic treatment?

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Correct answer: C — Low-dose aspirin (100 mg daily)

In obstetric antiphospholipid syndrome (recurrent miscarriages with persistently positive antiphospholipid antibodies but no prior thrombosis), low-dose aspirin (100 mg daily) is recommended for primary thromboprophylaxis. During pregnancy, low-dose aspirin PLUS prophylactic-dose LMWH (enoxaparin 40 mg daily) significantly improves live birth rates. Full-dose anticoagulation is reserved for patients with a history of thrombosis. Hydroxychloroquine has emerging evidence for additional benefit.

Reference: eTG – 2025 – Haematology; EULAR – 2019 – APS Management Recommendations