Diagnosis and Key Points

The patient, a 36-year-old woman, presented with a stroke and has triple positivity for antiphospholipid antibodies. Although the diagnostic criteria require persistent positivity for 12 weeks, her clinical presentation and positive laboratory tests strongly suggest antiphospholipid syndrome. The most important factor in risk stratification is the presence of lupus anticoagulant, which is the strongest predictor of future thrombotic events. Warfarin is the recommended anticoagulant for long-term management, as studies have shown superior outcomes compared to DOACs. However, in patients with a single positive antibody and a low-risk thrombotic event, shared decision-making and consideration of alternatives like DOACs may be appropriate. Aspirin is generally not added unless there is a specific indication like acute arterial breakthrough thrombosis or in the presence of other risk factors. Hydroxychloroquine may be considered as an adjunctive therapy in certain outpatient scenarios. The final treatment plan should be discussed collaboratively with the patient's neurologist and hematologist.