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Dr. Mukesh: Beyond ‘aPL Thrombosis’ – A Modern Approach to APS
Dr. Mukesh/AI Generated
Sep 4, 2026, 03:18

Dr. Mukesh: Beyond ‘aPL Thrombosis’ – A Modern Approach to APS

Dr. Mukesh, Assistant Professor of Clinical Immunology and Rheumatology at King George’s Medical University (KGMU), shared a post on X:

“Antiphospholipid Syndrome | 2026 update APS is no longer simply ‘aPL  thrombosis.’

Think phenotype plus antibody profile plus thrombotic risk.

Classification is not diagnosis.

  • 2023 ACR/EULAR criteria: approximately 99% specificity, approximately 74% sensitivity.
  • Obstetric APS: sensitivity only approximately 20-31%.

Don’t rule out APS by the score alone.

Look beyond thrombosis.

  • Microvascular disease,
  • valve disease,
  • thrombocytopenia,
  • renal or neurological involvement are important APS phenotypes.

Identify high-risk APS.

  • Lupus anticoagulant.
  • Double or triple positivity.
  • Arterial or microvascular disease.

VKA remains the anchor.

DOACs? Think twice.

Avoid rivaroxaban in triple-positive APS.

For most thrombotic APS – particularly high-risk disease – VKA remains preferred.

  • Recurrent thrombosis?

Before intensifying therapy:

  • Adherence – INR/TTR – provoking factors – APS risk profile.
  • Then consider LDA / intensified VKA / LMWH in selected patients.

Obstetric APS

  • LDA plus heparin or LMWH remains the foundation.
  • Refractory disease – specialist-directed escalation; HCQ remains an emerging option.

HCQ: Promising, not practice – changing – yet

  • 2026 data suggest fewer recurrent thrombotic events, but evidence remains small and heterogeneous.

Practical take-home

  • Suspect clinically – confirm persistent aPL – phenotype or risk-stratify – choose anticoagulation accordingly.

High-risk APS? – VKA. Triple-positive? – Avoid rivaroxaban.

Recurrent event? – Investigate before simply escalating.

Obstetric APS? – LDA plus heparin or LMWH.

The future: precision APS care – not one-size-fits-all anticoagulation.”

Dr. Mukesh

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Anticoagulation aPL APS Dr. Mukesh HCQ Health Hematology Hemostasis Hemostasis News Hemostasis Today Heparin Immunological and clotting disorders INR International Society on Thrombosis and Haemostasis LMWH Medicine platelets thrombosis TTR VKA
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