Patients with thrombotic antiphospholipid syndrome (APS) frequently require interruption of anticoagulation for invasive procedures, yet data to guide perioperative management remain limited. We conducted a single-center retrospective cohort study of adults with thrombotic APS who underwent planned periprocedural interruption of anticoagulation between 2016 and 2025. Primary outcomes were the 30-day risks of arterial thromboembolism (ATE), venous thromboembolism (VTE), and major bleeding; secondary outcomes included clinically relevant non-major bleeding (CRNMB), microvascular APS manifestations, and catastrophic APS (CAPS). Among 172 patients undergoing 282 interruptions, most (84.9%) received warfarin, and 25% were triple-positive (anti-cardiolipin, anti-β2-glycoprotein I, and lupus anticoagulant). Bridging with low-molecular-weight heparin (LMWH) was used in 84.7% of warfarin interruptions. Therapeutic-dose bridging was more frequently used in patients with triple-positive APS (OR 7.6; 95%CI 3.2-18.2) and in those with prior ATE (OR 3.4; 95%CI 1.5-7.8). The 30-day risk of ATE was 0.7% (95%CI 0.2-2.6). Major bleeding occurred in 0.7% (95%CI 0.2-2.6), with both events following high-bleed-risk procedures. One bleeding event was fatal, corresponding to a mortality risk of 0.4% (95%CI 0.1-2.0). CRNMB occurred in 3.2% (95%CI 1.7-6.0). A single case of probable CAPS occurred in a triple-positive patient receiving postoperative prophylactic LMWH. Guideline-directed perioperative anticoagulation management tailored to individual thrombotic and procedural bleeding risks appears feasible and safe. Our findings support individualized, risk-adapted perioperative anticoagulation management in APS.
Paquette et al. (Tue,) studied this question.