Prevention of thrombosis in patients with APS remains a vexing clinical problem. In patients with a history of thrombosis, there is considerable risk of recurrence, and long-term anticoagulation treatment with warfarin is effective in most cases. Existing evidence suggest that the use of DOACs for secondary thromboprophylaxis for APS patients with previous VTE is promising. Until new data from ongoing clinical trials are available, there is not enough evidence to consider using DOACs in patients with APS and previous arterial events. The efficacy of heparin and low-dose aspirin in APS patients with previous pregnancy losses is supported by 3 meta-analysis available on the topic. In patients with antiphospholipid antibodies but without a previous thrombotic event, most physicians in the field recommend thromboprophylaxis with low-dose aspirin. Given the diversity of clinical presentations and medical specialties involved, it is not surprising that treatment of APS has been subject of intense debate. Due to the difficulty in conducting trials in the setting of a relatively rare condition, well designed multicenter studies (such as registries) using actual classification criteria and standardized tests should be performed in the future to answer all the opened questions regarding management of APS.
Disclosure of Interest None declared