1. SLE diagnosis |
2. Check cardiovascular/thrombotic risk factors (at diagnosis and repeat according to individual patient characteristics and risk levels), including:  - aPL antibodies (if present define the aPL-associated risk profile)  - Traditional CVD risk factors (e.g., smoking, obesity, dyslipidemia, hypertension, diabetes, CVD family history)  - SLE-specific CVD risk factors (disease duration, disease activity, renal disease, GCs, hyperhomocysteinemia)  - Acquired hypercoagulability (e.g., major surgery/trauma, immobilization, pregnancy, malignancies, smoking, nephrotic syndrome)  - Hereditary hypercoagulability (e.g., factor V Leiden, prothrombin mutation, protein C deficiency a, protein S deficiency a, antithrombin deficiency a, elevated factor VIII activity a, hyperhomocysteinemia a) |
3. Correct any modifiable risk factor (lifestyle modifications, pharmacologic therapies) and:  - Hydroxychloroquine is recommended for all SLE patients (unless contraindicated) and should also be considered to reduce the risk of CVD  - Low disease activity (at the lowest possible GCs dose) should be maintained to also reduce CVD risk  - In asymptomatic aPL carriers (no history of thrombosis or pregnancy complications) prophylactic treatment with LDA is recommended, particularly in high-risk aPL profile patients  - In patients with definite APS, long-term VKA is recommended (if recurrent thrombosis despite adequate VKA treatment, an increase of INR target or addition of LDA should be considered) |