A 35-year-old woman with SLE has a positive lupus anticoagulant and anti-cardiolipin IgG >40 GPL units on two occasions 12 weeks apart, without any thrombotic event. Which is the MOST appropriate thromboprophylaxis strategy?
- A No treatment; only observe
- B Low-dose aspirin (75–100 mg/day) ✓
- C Warfarin with target INR 2–3
- D Direct oral anticoagulant (rivaroxaban)
Correct answer: B. Low-dose aspirin (75–100 mg/day)
Explanation
In asymptomatic (no prior thrombosis) SLE patients with antiphospholipid antibodies (aPL), EULAR guidelines recommend low-dose aspirin as primary thromboprophylaxis, particularly in high-risk aPL profiles such as triple positivity or lupus anticoagulant positivity. Warfarin is reserved for secondary prevention after thrombotic events. Direct oral anticoagulants are inferior to warfarin in antiphospholipid syndrome based on the TRAPS trial (rivaroxaban vs warfarin).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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