In antiphospholipid syndrome with recurrent strokes, would you consider adding antiplatelets to warfarin?

I agree with Dr. @Dr. First Last. I have had patients with APS and recurrent thromboembolic events although not necessarily strokes to whom I have added aspirin and HCQ to the treatment regimen. I did this because she continued to have recurrent events. However, there is at least one article that ne...

This is a good question, especially noting the high rate of recurrent thrombotic events in non-treated patients with antiphospholipid syndrome (up to 29% if untreated, but still significant among treated patients, especially after an arterial event).

Edit: to jump to the punchline, I favor adding AS...

Agree with Dr. @Dr. First Last. There are limited data addressing this issue. The original guidelines published in Stroke a number of years back suggested that aspirin monotherapy was sufficient for secondary prophylaxis. However, most rheumatologists felt that was insufficient; especially since the...

Anticoagulation should be sufficient.

No addition of ASA to "well anticoagulated" patient -- may need to assess Factor II activity to make sure it is less than 20% for adequate inhibition of hemostasis.

There have been so many attempts to use various "antiplatelet drugs" over the past 5 decades, in various thrombophilic conditions -- ...

Agree with Drs. @Dr. First Last and @Dr. First Last about the increased risk of bleeding when adding aspirin to coumadin in patients with APS.

Add antiplatelet therapy