Do we know which patients with the antiphospholipid syndrome should receive long-term high dose anti-coagulation?

The standard treatment of thrombosis related to antiphospholipid antibodies is lifelong high-intensity oral anticoagulation. This standard is primarily based on retrospective evaluations of such patients. In this paper we give a summary of current treatment of deep leg vein thrombosis, pulmonary embolism, ischaemic stroke and transient ischaemic events in the general population and relate this to studies performed in patients with the anti-phospholipid syndrome (APS). It is concluded that many patients with APS can be treated with conventional doses of oral anticoagulants, and that anti-platelet drugs may have a role in the prevention of cerebral ischaemic events. Data from large scale prospective studies, which are underway, will ultimately identify the optimal treatment in individual patients.