Target INR for Anticoagulation in Antiphospholipid Syndrome with VTE

Evidence-Based Recommendation

• The American College of Chest Physicians (ACCP) strongly recommends a therapeutic INR range of 2.0-3.0 (target INR 2.5) for patients with VTE who are treated with vitamin K antagonists (VKAs) like warfarin 1
• For patients with APS and VTE, moderate-intensity warfarin (INR 2.0-3.0) is as effective as high-intensity warfarin (INR >3.0) but is associated with less bleeding risk 2

Special Circumstances

• Direct oral anticoagulants (DOACs) are NOT recommended for patients with APS, particularly those with triple-positive antiphospholipid antibodies, due to excess thrombotic events compared with warfarin 2, 3