As found from a retrospective study by Jill R Schofield et al., a personalized symptom-derived antithrombotic treatment may be linked with a low bleeding risk given its high rate of symptomatic response and long-term follow up in this study.

This study was aimed to assess the response to trials of antithrombotic therapy in total of 75 aPL-positive patients with refractory migraine. The patients were subjected to aspirin, clopidogrel and/or anticoagulation in this 2- 4 week trial. Response was evaluated as: Major response – 50 to 100% improvement in frequency and/or severity of migraine; Minor response- 25 to 49% improvement and no response- less than 25% improvement. 

Also, response rate to any anti-thrombotic therapy was 89% (83% being the major response). A lot of patients also described an improvement in the non-headache symptoms. None of the patients had stroke. No major bleeding was observed during 2–4 week treatment trial. During a follow-up of 29.9 months, only 3 out of 69 patients sustained on an antithrombotic therapy witnessed major bleeding.

Given the Class IV level of evidence of this study, the study authors highlight on the need of future randomized controlled trials to authenticate these promising outcomes.