Patients with systemic lupus erythematosus (SLE) who do not meet criteria for antiphospholipid syndrome but carry a high-risk antiphospholipid antibody (aPL) profile require targeted primary prophylaxis — a distinct management scenario from both uncomplicated SLE and overt APS.
This protocol addresses SLE patients without antiphospholipid syndrome who have a high-risk aPL profile, defined as:
Lupus anticoagulant positivity; or double antiphospholipid antibody positivity (any combination of lupus anticoagulant, anticardiolipin antibodies, or anti-beta2glycoprotein I antibodies); or triple antiphospholipid antibody positivity (all three).
Primary prophylaxis in this subgroup includes antiplatelet therapy. Additionally, an antimalarial agent is particularly recommended in these patients for its recognised antithrombotic properties. The complete structured regimen — full sequencing, clinical context, and evidence grading — is available via the button below.
DOI: 10.1136/ard-2023-224762
Low dose aspirin (75–100 mg/day) should be considered in patients with SLE without APS but with high-risk aPL profile (2a/B).
Primary prophylaxis with low-dose aspirin should be considered in those with a high risk aPL profile, defined as lupus anticoagulant positivity, or double (any combination of lupus anticoagulant, anticardiolipin antibodies or anti-beta2glycoprotein I antibodies) or triple aPL (all three aPL).
Apart from its other beneficial effects, HCQ has also potential antithrombotic effects and may reduce aPL levels, and is particularly recommended in patients with SLE-aPL or SLE/APS.
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