Treatment of Antiphospholipid Syndrome after a First Arterial Thrombosis
This protocol addresses definite antiphospholipid syndrome (APS) in patients who have experienced a first arterial thrombosis. The choice of anticoagulation and its intensity is determined by the individual's risk of recurrent thrombosis weighed against their risk of bleeding.
Treatment approach
In this setting, oral anticoagulation with a Vitamin K antagonist is the recommended cornerstone of therapy — evidence supports it over antiplatelet therapy alone. The appropriate anticoagulation intensity and whether an additional antiplatelet agent warrants consideration depend on the patient's individual risk profile. The complete protocol specifies the applicable targets and the conditions under which each option applies.
References
DOI: 10.1136/annrheumdis-2019-215213
- In patients with definite APS and first arterial thrombosis: Treatment with VKA is recommended over treatment with LDA only.
- Treatment with VKA with INR 2–3 or INR 3–4 is recommended, considering the individual's risk of bleeding and recurrent thrombosis.
- Treatment with VKA with INR 2–3 plus LDA may also be considered.