Cardiovascular disease and venous thrombosis prevention

Screening for and aggressive management of conventional atherosclerosis risk factors

Screening for and elimination of venous thrombosis risk factors

Patient education

Primary thrombosis prevention

Low-dose aspirin in persistently moderate-to-high titer aPL-positive patients who have additional cardiovascular risk factors. No evidence that aspirin benefits the patients who do not have additional cardiovascular risk factors

No anticoagulation except if indicated for other conditions

Secondary thrombosis prevention

Warfarin with a target international normalized ratio (INR) of 2.0–3.0 for venous thrombosis

Warfarin with a target INR of 2.0–3.0 with consideration of low-dose aspirin for arterial thrombosis (the group acknowledges the fact that given the lack of strong data on arterial thrombosis, some centers prefer warfarin with a target INR of 3.0–4.0)

No use of direct oral anticoagulants until the results of the ongoing randomized clinical trials are available

Indefinite anticoagulation in aPL-positive patients with unprovoked thrombosis with continuous assessment of the bleeding risk.

Optimal therapy of patients with provoked venous thrombosis is unknown. Therapy for a minimum of 3 months and until the provoking risk factor is eliminated should be provided to all patients. Strong consideration of extended duration anticoagulation recommended for most patients except perhaps those identified to have a high risk of bleeding.