Antithrombotic Treatment For Stroke Associated With Antiphospholipid Antibodies

The current mainstay of treatment of thrombotic antiphospholipid syndrome (APS) is long term warfarin; however, the optimal antithrombotic treatment for APS-related ischaemic stroke or transient ischaemic attacks (TIA) remains uncertain, as does the optimal intensity of anticoagulation. The risk of bleeding with increasing anticoagulant intensity needs to be balanced against the risk of profound permanent disability and death, or irreversible neurological deterioration as a result of recurrent stroke/TIA. Several experts recommend a target INR of 3.5 (range 3.0-4.0) for stroke associated with persistent antiphospholipid antibodies (aPL) which meet International consensus Updated Sapporo (Sydney) classification criteria, with a similar approach in patients with aPL-associated TIA. However, current guidelines recommend a target INR of 2.5 (2.0-3.0) in these patients. Prospective adequately powered clinical studies are required to determine the optimal antithrombotic approach including the potential role of oral direct inhibitors of coagulation for patients with aPL-associated stroke.