Triple aPL positivity is reportedly associated with a high risk for both first and recurrent thrombotic events.[14] The patient, in this case, was previously a heavy smoker and also had an infection, both of which are risk factors for thrombosis.[15] Although rivaroxaban is not reported as inferior to warfarin, it might not be as effective for triple-aPL-positive patients.[16] The patient in the present case was not properly diagnosed at an early stage, and so he missed the optimal therapeutic window for anticoagulation therapy. This evidence concerns the gene FASLG and infection.