Patient handout

STEMI — antiphospholipid syndrome related (arterial APS thrombosis)

PRODUCTION

1. Your condition

This handout is for stemi — antiphospholipid syndrome related (arterial aps thrombosis). Your care team identified this based on: st elevation on ecg in patient with known aps or triple-positive antibody profile.

Other reasons your team may use this plan: stemi in young patient (<50) with prior venous thrombosis or pregnancy losses → aps suspect; coronary cath shows thrombus burden disproportionate to atherosclerotic plaque → thrombophilia workup.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162-325 mg chewed → 81 mg daily LIFELONG	PO	load + daily LIFELONG	AHA 2025 Class I acute + EULAR 2019 APS Class I lifelong concurrent ASA with warfarin in arterial APS
ticagrelor	180 mg load → 90 mg BID × 12 mo	PO	BID × 12 mo DAPT	PLATO PMID 19717846; standard ACS DAPT applies to APS-STEMI
heparin_unfractionated	70-100 U/kg IV bolus then infusion to aPTT 1.5-2.5×control	IV	bolus + infusion	AHA 2025 Class I; UFH preferred over LMWH in APS for monitoring (anti-Xa more reliable than aPTT if LA prolongs baseline)
warfarin	5 mg daily; INR target 2.5-3.5 (HIGHER target for arterial APS vs 2-3 venous)	PO	daily LIFELONG	EULAR 2019 APS Class I; ASH 2018 (PMID 30482764); arterial APS — INR 2.5-3.5; LIFELONG (no taper); NEVER interrupt without bridge — interruption is leading APS thrombosis trigger
atorvastatin	80 mg daily	PO	daily	PROVE-IT PMID 15007110; pleiotropic anti-inflammatory effect may also benefit APS endothelial dysfunction
hydroxychloroquine	200-400 mg daily (≤5 mg/kg ideal weight)	PO	daily	EULAR 2019 weak recommendation — HCQ reduces APS thrombosis risk especially with SLE overlap; consider in refractory/recurrent disease

Plan: APS-related STEMI long-term anticoagulation — WARFARIN preferred (NOT DOAC) per TRAPS arterial subset

3. When to call your provider

Contact your care team if any of the following happen:

Recurrent thrombosis → escalate AC intensity, add HCQ, consider rituximab (refractory CAPS)
Pregnancy → switch to LMWH + ASA immediately, rheumatology + MFM consult

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Multi-organ thrombosis (≥3 organs) in <1 wk in known/suspect APS — Catastrophic APS (CAPS); mortality 50% without aggressive triple therapy(life-threatening)
Patient with known APS placed on DOAC (rivaroxaban/apixaban/edoxaban) for AC — TRAPS showed inferior outcomes vs warfarin in arterial APS subset
Patient with prior APS-related arterial event (STEMI) becomes pregnant — warfarin teratogenic + fetal hemorrhage; need LMWH + ASA bridge
Recurrent arterial or venous thrombosis despite documented therapeutic INR 2.5-3.5 — APS treatment failure

5. Follow-up

Cardiology + rheumatology + hematology multidisciplinary follow-up; lifelong warfarin INR 2.5-3.5 + ASA; hydroxychloroquine if SLE overlap (may reduce APS thrombosis); avoid OCPs/HRT (estrogen worsens APS)

6. Sources

Guideline: 2025 ACC/AHA ACS + ESC 2023 ACS + EULAR 2019 APS Management + ASH 2018 Thrombophilia