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Antiphospholipid syndrome — SCE Rheumatology MCQ

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HardConnective tissue diseasesAntiphospholipid syndromeSCE Rheumatology

A triple-positive APS patient has recurrent ischaemic stroke despite confirmed adherence to warfarin with INR 2.0–3.0 and no competing embolic source. Which specialist strategy is supported by EULAR?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Add aspirin, raise the INR target, or switch to LMWH after reassessment

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · A = shown as D

D is correct. After adherence, INR history and other stroke mechanisms are checked, EULAR-supported options include aspirin addition, a higher INR target or LMWH. A is inappropriate in triple-positive APS. B denies verified treatment failure. C withdraws anticoagulation from a high-risk disorder. E creates unvalidated dual anticoagulation with excessive bleeding risk.

Reference: EULAR recommendations for management of antiphospholipid syndrome: https://ard.bmj.com/content/78/10/1296