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What is the epidemiology of aPL-related morbidity and mortality in pregnancy?
• Recurrent first trimester loss: 15-20% of women aPL+.
• Rai RS et al, Hum Reprod 1995 • Stillbirth Collaborative Research Network: 11% aPL+.
• Page et al, Obstetric and Gynecol 2017 • Severe PET/IUGR NO DATA
Scenario
Treatment
Women with aPL,
No clinical features of APS
or women with recurrent first trimester loss (<3)
Pregnancy: Low dose aspirin (LDA) Puerperium: Prophylactic LMWH for 7 days
Women with aPL and 3 consecutive pregnancy losses (<10 weeks) but no thrombosis
Pregnancy: LDA +/- prophylactic LMWH (if so, stop at 20 weeks if uterine artery Doppler normal)
Puerperium: prophylactic LMWH for 7 days.
Women with adverse obstetric outcomes (2nd trimester loss, early onset PET, HELLP, previous growth restricted child, preterm delivery) but NO thrombosis
Pregnancy: LDA + prophylactic LMWH Puerperium: prophylactic LMWH for 7 days.
Women with thrombotic APS treated with long- term VKA
Pregnancy: LDA + therapeutic LMWH Puerperium: Switch to VKA
Women with APS and acute thrombotic event during pregnancy
Pregnancy: LDA + high therapeutic LMWH Puerperium: Switch to VKA
Adapted from protocol for treatment of women with aPL in pregnancy; St Thomas’ Hospital
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