Antiphospholipid Syndrome Recommendations for Antiphospholipid Syndrome Referenced studies that support recommendations are summarized in online Data Supplement 46. COR LOE Recommendations In patients with ischemic stroke or TIA who have an isolated antiphospholipid antibody but do not fulfill the criteria for antiphospho- lipid syndrome, antiplatelet therapy alone is recommended to reduce the risk of recurrent In patients with ischemic stroke or TIA with confirmed antiphospholipid syndrome treated with warfarin, it is reasonable to choose a target INR between 2 and 3 over a target INR >3 to effectively balance the risk of excessive bleeding against the risk of thrombosis.613 615 In patients with ischemic stroke or TIA who meet the criteria for the antiphospholipid syndrome, it is reasonable to anticoagulate with warfarin to reduce the risk of recurrent stroke or TIA.615 3: Harm B-R In patients with ischemic stroke or TIA, antiphospholipid syndrome with history of thrombosis and triple-positive antiphospholipid antibodies (ie, lupus anticoagulant, anticardio- lipin, and anti 2 glycoprotein-I), rivaroxaban is not recommended because it is associated with excess thrombotic events compared with Synopsis Antiphospholipid syndrome is characterized by persistent (repeat testing 12 weeks apart) presence of lupus anti- coagulant, anti-cardiolipin or anti 2 glycoprotein I high- titer antibodies, plus evidence of clinical criteria such as vascular thrombosis or pregnancy morbidity.619 Serum testing for acquired antiphospholipid syndrome may be considered in the presence of a history of prior venous thromboembolism, second trimester abortion, or rheu- matologic disorder. Patients with stroke and persistent seropositivity for any of the antiphospholipid antibodies may be classified as having antiphospholipid syndrome. Recommendation-Specific Supportive Text 1. A large subgroup of WARSS (Warfarin-Aspirin Recurrent Stroke Study) was studied to evaluate whether the presence of a positive antiphospholipid antibody indicated a treatment interaction with warfarin or aspirin for secondary stroke preven- tion. 