Survey on antiphospholipid syndrome diagnosis and antithrombotic treatment in patients with ischemic stroke, other brain ischemic injury, or arterial thromboembolism in other sites: communication from ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies

BACKGROUND: The optimal strategy for diagnosis and antithrombotic treatment of patients with antiphospholipid syndrome (APS)-associated acute ischaemic stroke (AIS), transient ischaemic attack (TIA) or other brain ischaemic injury is poorly defined. OBJECTIVES: The survey goal was to capture variations in diagnosis and antithrombotic treatment of APS-associated ischaemic stroke and related disorders, to inform guidance and clinical trials to define optimal management. METHODS: Key opinion leaders/workers were invited to complete a REDCap survey questionnaire initiated by the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies. The survey data were tallied using simple descriptive statistics. RESULTS: There was generally good agreement on several aspects, including which patients to test for antiphospholipid antibodies (aPL); use of lifelong vitamin K antagonist for AIS or recurrent TIA; and formal cognitive assessment for suspected cognitive impairment. There was less agreement on other aspects, including aPL testing for brain ischaemic injury other than AIS/TIA, or if an alternative cause for AIS or TIA exists; choice of aPL tests, their timing and age cut-off; the aPL phenotype to trigger antithrombotic treatment; management for patent foramen ovale; antithrombotic treatment for first TIA or white matter hyperintensities; head magnetic resonance imaging specifications; low-molecular-weight heparin dosing/anti-Xa monitoring in pregnancy. The survey highlighted that approximately 25% do dedicated APS clinics and <50% have a multidisciplinary team structure for APS patients. CONCLUSIONS: Much of the variation in practice reflects the lack of evidence-based recommendations. The survey results should inform the development of a more uniform multidisciplinary consensus approach to diagnosis and antithrombotic treatment