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Antiphospholipid syndrome — SCE Rheumatology MCQ

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HardConnective Tissue DiseasesAntiphospholipid syndromeSCE Rheumatology

A 44-year-old man has triple-positive antiphospholipid syndrome after an ischaemic stroke and previous DVT. He is stable on warfarin but asks to switch to a direct oral anticoagulant for convenience. Renal function is normal and he has no bleeding history. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: A — Continue vitamin K antagonist anticoagulation

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

Continue vitamin K antagonist anticoagulation is best because high-risk triple-positive APS with arterial thrombosis is best managed with vitamin K antagonist anticoagulation rather than DOAC substitution. A is less suitable because clopidogrel monotherapy does not address APS anticoagulation needs; C is less suitable because aspirin alone is inadequate after thrombotic APS; D is less suitable because rivaroxaban is associated with concern in high-risk APS, particularly arterial events; E is less suitable because prophylactic-dose heparin is not long-term treatment for prior arterial and venous thrombosis. Clinical pearl: triple positivity and arterial thrombosis are key flags against DOAC use.

Reference: BSH APS guideline 2024; EULAR APS recommendations