How would you manage a patient with antiphospholipid syndrome in the setting of severe steroid-refractory thrombocytopenia?

Dr. @Dr. First Last answered the question of severe thrombocytopenia in a patient with APS and an acute thrombotic stroke. I agree with his approach. However, this “between a rock and a hard place” clinical scenario does also appear not infrequently during the chronic management of patients with APS...

I would like some more information on the patient, such as age, bleeding history/risk, other cardiometabolic risk factors, other meds, etc. But in general, I agree with anticoagulation. Clearly, it would be helpful to get the platelet count up quickly--though even at 50,000 I would not hold anticoag...