Haematology · NEET PG Preparation Medicine
A 32-year-old female presents with recurrent episodes of unprovoked deep venous thrombosis and pulmonary embolism. Laboratory workup reveals a prolon…
Practice question from Haematology (NEET PG Preparation Medicine), with the correct answer and a step-by-step solution.
medium · MCQ · Q-D2B60B
A 32-year-old female presents with recurrent episodes of unprovoked deep venous thrombosis and pulmonary embolism. Laboratory workup reveals a prolonged activated partial thromboplastin time (aPTT) that does not correct upon 1:1 mixing with normal pooled plasma. Further testing shows a positive dilute Russell viper venom time (dRVVT) and anticardiolipin antibodies. Which of the following is the most appropriate long-term management for this patient?
- A.Indefinite anticoagulation with low-molecular-weight heparin or warfarin targeting an INR of 2.0-3.0Correct answer
- B.Direct oral anticoagulants (DOACs) as first-line therapy
- C.Lifelong aspirin monotherapy
- D.Prophylactic placement of an inferior vena cava (IVC) filter without anticoagulation
Solution
The patient has antiphospholipid syndrome (APS), characterized by thrombosis, pregnancy morbidity, and persistent laboratory evidence of antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, or anti-beta2-glycoprotein I). The correction failure in the mixing study is classic for a lupus anticoagulant. For patients with unprovoked venous thromboembolism and definite APS, lifelong/indefinite vitamin K antagonist (warfarin) therapy targeting an INR of 2.0-3.0 is standard. DOACs are generally not preferred for high-risk APS patients, especially those with arterial thrombosis or triple positivity.
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