Primary thromboprophylaxis for asymptomatic people with SLE and persistent aPL antibodies who are thromboembolism-free

Note: The presence of persistent antiphospholipid (aPL) antibodies alone does not confirm a diagnosis of antiphospholipid syndrome, even if the patient has SLE.

Systemic lupus erythematosus (SLE) is commonly associated with persistent aPL antibodies (in approximately 40%). SLE is the most common inflammatory connective tissue disease associated with antiphospholipid syndrome; less frequently, Sjögren syndrome, rheumatoid arthritis and systemic sclerosis may be associated. If there are no clinical manifestations to suggest antiphospholipid syndrome, the presence of aPL antibodies alone does not confirm a diagnosis of SLE-associated antiphospholipid syndrome.

Hydroxychloroquine is the mainstay of therapy for SLE-associated antiphospholipid syndrome. Despite a lack of clinical outcome data, all people with SLE should take regular hydroxychloroquine (unless contraindicated) for its:

  • effects on reducing aPL-antibody titres
  • antiaggregant effect on platelets
  • lipid-lowering effect
  • few harms.

See Hydroxychloroquine for SLE in adults for more detail and dosing. For additional considerations in prescribing hydroxychloroquine, see Specific considerations for use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

For asymptomatic people with SLE, or other inflammatory connective tissue disease, who have persistent aPL antibodies, consider low-dose aspirin on an individual basis (eg for someone with a high-risk aPL-antibody profile)Tektonidou, 2019. For management advice including prophylactic use of low-dose aspirin, see Primary thromboprophylaxis for asymptomatic people with persistent aPL antibodies who are thromboembolism-free.

All people with SLE, and especially those with aPL antibodies, who are trying to conceive should be encouraged to discuss their plans with their general practitioner and specialist because ideally, pregnancy should be a planned event; see Considerations for people with SLE planning pregnancy.