Anticoagulation and antiplatelet therapy for recurrent thromboembolism in thrombotic antiphospholipid syndrome

Note: People with recurrent thromboembolism in thrombotic antiphospholipid syndrome require full anticoagulation plus antiplatelet therapy, and sometimes other therapies, to reduce recurrence.

Recurrent thromboembolism may occur in people with thrombotic antiphospholipid syndrome who are already on thromboprophylaxis (typically with warfarin). These people require initial full anticoagulation with heparin for their recurrent thromboembolic event, and the addition of antiplatelet therapy. Drugs that may be used in combination with warfarin include low-dose aspirin, or dipyridamole plus aspirin. If antiplatelet therapy is indicated for a patient with antiphospholipid syndrome and recurrent thromboembolism, use:

1aspirin 100 to 150 mg orally, daily aspirin aspirin aspirin

OR

1dipyridamole modified-release+aspirin 200+25 mg orally, twice daily. dipyridamole + aspirin dipyridamole+aspirin dipyridamole+aspirin

Hydroxychloroquine may be added to anticoagulants and antiplatelet therapy. Patients with SLE will typically already be taking hydroxychloroquine for long-term disease management. Patients who do not have SLE may consider a trial of oral hydroxychloroquine because of its:

  • effects on reducing aPL-antibody titre
  • 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).