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Antiphospholipid syndrome with PE — SCE Respiratory MCQ

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HardPulmonary Vascular DiseaseAntiphospholipid syndrome with PESCE Respiratory

A 45-year-old woman has recurrent unprovoked PE and triple-positive antiphospholipid antibodies on repeat testing 12 weeks apart. She completed 6 months of apixaban after the second event. What is the most appropriate long-term anticoagulant?

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Correct answer: A — Warfarin with specialist anticoagulation follow-up

Triple-positive antiphospholipid syndrome with recurrent VTE is best managed with warfarin rather than a DOAC. Continuing apixaban is less favoured in high-risk APS because of recurrent thrombosis concerns. Aspirin, stopping treatment or intermittent prophylaxis would not provide adequate secondary prevention.

Reference: NICE NG158; BSH Antiphospholipid Syndrome guidance