VTE in SLE without APS — RACP Adult Medicine MCQ

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ModerateRheumatologyVTE in SLE without APSRACP Adult Medicine

A 40-year-old man with SLE develops sudden onset severe pleuritic chest pain, tachycardia, and hypoxia. D-dimer is elevated. CTPA shows bilateral pulmonary emboli. He has no antiphospholipid antibodies. What is the recommended anticoagulant?

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Correct answer: A — Apixaban or rivaroxaban (DOAC)

For SLE patients WITHOUT antiphospholipid antibodies who develop VTE, DOACs (apixaban, rivaroxaban) are the preferred first-line anticoagulant, as in the general population. The critical distinction is that DOACs are CONTRAINDICATED in antiphospholipid syndrome (particularly triple-positive APS – TRAPS trial showed increased thrombotic events). For SLE patients WITH APS, warfarin is the preferred anticoagulant. Always check antiphospholipid antibody status in any SLE patient presenting with thrombosis.

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