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Antiphospholipid syndrome — SCE Rheumatology MCQ

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HardPregnancy and rare rheumatic diseaseAntiphospholipid syndromeSCE Rheumatology

A patient with thrombotic antiphospholipid syndrome has recurrent venous thrombosis despite confirmed adherence and repeatedly therapeutic INR 2.0–3.0. What is the most appropriate next step?

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Correct answer: A — Specialist review for intensified warfarin or low-molecular-weight heparin

Recurrent thrombosis despite therapeutic warfarin requires confirmation of adherence, INR quality and the event, followed by specialist consideration of a higher INR target, low-molecular-weight heparin or selected adjunctive aspirin. Direct oral anticoagulants are unsuitable for high-risk APS, particularly triple-positive disease.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions