The Fellow on Call: The Heme/Onc Podcast Episode 135: VTE Series - Management of Antiphospholipid Antibody Syndrome
May 7, 2025
Delve into the management of antiphospholipid antibody syndrome with insights on anticoagulants. Discover if a higher INR is indeed better for warfarin and explore the role of Direct Oral Anticoagulants. The hosts debate the optimal timing for APLS testing—don't miss their lively back-and-forth! A recent trial sheds light on transitioning patients from warfarin to rivaroxaban, scrutinizing its findings. Plus, learn about the comparative effects of apixaban and warfarin in this complex treatment landscape.
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Warfarin Preferred for Thrombotic APLS
- Use warfarin as the preferred anticoagulant for thrombotic antiphospholipid antibody syndrome (APLS) with a target INR of 2-3.
- Confirm INR accuracy especially if lupus anticoagulant affects baseline clotting tests when managing APLS patients.
Standard INR 2-3 Is Appropriate
- A 2003 NEJM randomized trial found no benefit of higher INR targets over standard 2-3 INR in preventing APLS thrombosis.
- Aim for standard intensity anticoagulation unless specific indications exist for higher INR.
Triple Positivity Increases Thrombosis Risk
- Triple positive APLS patients (positive for lupus anticoagulant, anti-beta glycoprotein, and anticardiolipin antibodies) have highest risk of both venous and arterial clotting.
- Lupus anticoagulant positivity is the strongest individual predictor of thrombosis risk in APLS.