An INR with a target range of 2 to 3 is preferable over an INR with a range >3 because higher-intensity anticoagulation is not superior in preventing thrombotic events and is associated with a higher risk of hemorrhagic com- When anticoagulation has been tested against aspirin, an INR of 2 to 3 is a typi- cal range to be used as a comparison arm, further supporting the use of this therapeutic range as 3. Limited evidence favors anticoagulation with VKA compared with aspirin to reduce recur- rent arterial thromboses. In a small (N=20) RCT, patients with antiphospholipid syndrome were assigned to a single-antiplatelet arm versus tri- ple-therapy arm (dual antiplatelets plus antico- agulation). Participants with single antiplatelets had a higher risk of recurrent stroke (log-rank test, P=0.026) with similar rates of hemorrhage during a mean follow-up of 3.9 years.615 There are limited data to establish whether the addition of antiplatelets to anticoagulation is effective in reducing the risk of recurrent stroke in this pop- ulation. The clinical consensus favors using only CLINICAL STATEMENTS AND GUIDELINES Kleindorfer 4. The role of DOACs in antiphospholipid syndrome treatment is the focus of multiple ongoing and recently completed studies. In an open-label, noninferiority RCT of patient with established antiphospholipid syndrome and triple-positive antiphospholipid antibodies, rivaroxaban was asso- ciated with higher risk of thrombotic events.616 A similar result in favor of VKA over rivaroxaban was reported in an open-label RCT of patients with antiphospholipid syndrome. 