A 38-year-old woman with SLE has a positive lupus anticoagulant, anti-cardiolipin IgG antibodies (>40 GPL units), and anti-beta-2-glycoprotein-I antibodies on two occasions 12 weeks apart. She has no prior thrombosis. What is this serological profile called and what prophylactic treatment is recommended?
- A Triple-positive antiphospholipid syndrome; start warfarin with INR 2–3
- B Secondary APS; no treatment required unless thrombosis occurs
- C APS; start rivaroxaban for primary prophylaxis
- D Triple-positive antibody profile; start hydroxychloroquine and low-dose aspirin ✓
Explanation
Triple-positive antiphospholipid antibody (aPL) profile (positive LA + high-titer aCL + anti-β2GPI) confers the highest thrombotic risk. In SLE patients with triple-positive aPL but no prior thrombosis (primary prophylaxis setting), current guidelines recommend hydroxychloroquine (which has anti-thrombotic properties) plus low-dose aspirin. Anticoagulation with warfarin is reserved for secondary prophylaxis after a confirmed thrombotic event. DOACs like rivaroxaban are inferior to warfarin in triple-positive APS (shown in the RAPS and TRAPS trials) and are not recommended.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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