26th February 2025

Management of antiphospholipid syndrome

Decisions surrounding use of antiplatelet agents and anticoagulation are complex and depend on whether there has been a previous clot, whether there is concomitant SLE and whether the thrombotic event was provoked. 

• Hydroxychloroquine is used in patients with concomitant SLE, as it has anticoagulant and anti-inflammatory activity.
• Those who have had unprovoked thrombotic events are usually treated with warfarin (target INR 3-4). DOACs are not generally used as there is limited evidence regarding their safety and efficacy in APLS.
• In pregnancy, mothers are usually given low-dose aspirin and low-molecular-weight heparin (LMWH) – treatment dose with previous thrombosis, otherwise prophylactic dose.
• In refractory cases, rituximab (anti-CD20 B cell-depleting monoclonal antibody) can be used.