Antiplatelets Show Better Net Clinical Benefit vs Warfarin in aPL-Positive Stroke, TIA

Background: Warfarin is commonly recommended for antiphospholipid syndrome (APS)–associated ischemic stroke/transient ischemic attack (TIA), but evidence is limited and warfarin adds monitoring and bleeding burdens. Real-world practice often uses antiplatelet regimens; comparative net-benefit data in antiphospholipid antibody (aPL)–positive stroke populations are needed. Objective: To compare net clinical benefit across secondary prevention regimens in patients with aPL-related stroke/TIA. Design: Retrospective, single-center cohort study conducted at Seoul National University Hospital, Korea, from February 2013 to June 2022; time-varying Cox models were used with multivariable adjustment. Methods: 167 aPL-positive ischemic stroke/TIA patients initially treated with warfarin (n=19), single antiplatelet therapy (SAPT; n=32), dual antiplatelet therapy (DAPT; n=91), or direct oral anticoagulants (DOACs; n=25) were eligible. Mean age ranged from 49.4 ± 17.0 years (warf more...