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Antiphospholipid syndrome — SCE Rheumatology MCQ

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HardPregnancy and rare rheumatic diseaseAntiphospholipid syndromeSCE Rheumatology

A patient with confirmed thrombotic antiphospholipid syndrome has a first unprovoked proximal venous thrombosis. Which long-term anticoagulant strategy is preferred?

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Correct answer: D — Long-term warfarin anticoagulation with a target INR of 2.0–3.0

Long-term warfarin with a target INR of 2.0–3.0 is standard after a first unprovoked venous thrombosis in thrombotic APS. Direct oral anticoagulants are avoided in triple-positive or arterial APS and used only selectively elsewhere.

Reference: BSH guideline on investigation and management of antiphospholipid syndrome (Published July 2024; reviewed August 2025): https://cms.b-s-h.org.uk/guidelines/guidelines/guidelines-on-the-investigation-and-management-of-antiphospholipid-syndrome; EULAR recommendations for management of antiphospholipid syndrome (Published 2019): https://ard.bmj.com/content/78/10/1296