What is the treatment for a patient who had a noncerebral arterial thrombosis and elevated levels of Antiphospholipid Antibodies?
• If a patient is at medium risk for recurrence (no LA, no prior clot, no cardiovascular risk factors, no SLE) and/or at high bleeding risk, then treatment can be combination antiplatelet agents (ASA [81 mg daily] plus clopidogrel [75 mg daily] or ASA plus ticagrelor [90 mg twice a day]). Some experts feel that combination of antiplatelet agents (ASA plus clopidogrel or ticagrelor) is more effective than warfarin-based therapies for any arterial thrombosis.
• If a patient is at high risk for recurrence (triple positive aPL abs, active SLE, prior clot, smoking), treatment should be warfarin (INR 2 to 3) plus antiplatelet therapy or high-dose warfarin (INR 3 to 4).
• If a patient is at high risk for recurrence and has a vascular stent, then treatment should be warfarin (INR 2 to 3), ASA (81 mg daily), and clopidogrel (75 mg daily) or ticagrelor (90 mg twice a day) in combination.
Adjunctive therapy should be directed at modifying cardiac risk factors. Notably, statin therapy may decrease clotting risk by decreasing endothelial activation in APS patients. Due to recurrence risk, lifelong therapy should be used.
