Management of Antiphospholipid Syndrome

Primary Prevention Strategy

The American College of Rheumatology recommends initiating low-dose aspirin 75-100 mg daily for primary prevention in patients with confirmed antiphospholipid antibodies and no prior thrombotic events, especially with a family history of APS 1, 2, 3
The European League Against Rheumatism suggests adding hydroxychloroquine 200-400 mg daily if lupus features are present, as it provides additional thrombotic protection and may decrease APS complications 1, 5

The American College of Rheumatology recommends repeating antiphospholipid antibody testing in 12 weeks to confirm persistent positivity, as transient antibodies do not warrant long-term treatment 3
The European League Against Rheumatism suggests monitoring closely for thrombotic symptoms, such as unexplained leg swelling/pain, chest pain/dyspnea, focal neurologic deficits, or pregnancy complications 5

The American College of Chest Physicians recommends initiating warfarin with a target INR 2.0-3.0 for indefinite duration in patients with venous thromboembolism, and avoiding direct oral anticoagulants (DOACs) due to increased thrombotic events compared to warfarin in APS patients 6, 3, 5
The European League Against Rheumatism suggests considering higher-intensity warfarin (INR 3.0-4.0) for arterial events, including stroke/TIA, and adding low-dose aspirin to warfarin for combined therapy in arterial thrombosis 3, 5

The American College of Rheumatology recommends initiating low-dose aspirin 81-100 mg daily before 16 weeks gestation and continuing through delivery, and adding prophylactic-dose low molecular weight heparin if obstetric APS criteria are met 7, 2, 5
The European League Against Rheumatism suggests continuing hydroxychloroquine throughout pregnancy if already prescribed, as it is safe and reduces lupus flares, and avoiding warfarin during pregnancy due to teratogenic effects 7, 2