Table 5

GLADEL–PANLAR recommendations for adult patients with SLE with antiphospholipid antibodies or antiphospholipid syndrome

Antiphospholipid syndrome
Treatment recommendationsQuality of the evidenceStrength of recommendation
In adult patients with lupus with APS and venous thromboembolic disease
Use extended over time-limited anticoagulation.ModerateStrong
Use standard-intensity anticoagulation (INR 2.0–3.0) over high-intensity anticoagulation (INR 3.0–4.0).Very lowStrong*
In adult patients with SLE with APS and stroke
Use high-intensity anticoagulation (INR 3.0–4.0) over standard-intensity anticoagulation (INR 2.0– 3.0) or LDA.Very lowWeak
In pregnant lupus women with obstetric APS and recurrent pregnancy losses
Use HCQ plus LMWH plus LDA over HCQ plus LDA, or adding GCs or intravenous Ig.ModerateStrong
  • *Strong recommendation supported on high certainty in significant bleeding risk increase with high-intensity anticoagulation.

  • APS, antiphospholipid syndrome; GC, glucocorticoid; GLADEL, Grupo Latino Americano del Estudio de Lupus; HCQ, hydroxychloroquine; Ig, immunoglobulin; INR, international normalised ratio; LDA, low-dose aspirin; LMWH, low molecular weight heparin; PANLAR, Pan-American League of Associations of Rheumatology; SLE, systemic lupus erythematosus.