Preconception and pregnancy thromboprophylaxis for people with a history of obstetric antiphospholipid syndrome

Erkan, 2001Sammaritano, Bermas, 2020

Specialist management is recommended for people with a history of obstetric antiphospholipid syndrome throughout preconception, pregnancy and the postpartum period; preconception assessment and counselling is recommendedUthman, 2019. This is particularly important for patients with systemic lupus erythematosus (SLE); see also Reproductive health in people with SLE.

For people with a history of obstetric antiphospholipid syndrome who becomes pregnant, prophylactic anticoagulants and antiplatelet therapy (including low molecular weight [LMW] heparin and low-dose aspirin) are recommended for the duration of the pregnancy and for 6 to 12 weeks postpartum. Prolonged use of LMW heparin (eg for the duration of pregnancy or multiple failed pregnancies) is a risk factor for osteoporosis.

If someone with a history of obstetric antiphospholipid syndrome develops a thromboembolic complication (with no history of previous thromboembolism), manage them as for a first thromboembolic episode in thrombotic antiphospholipid syndrome.

Additional treatment strategies that may be considered by a specialist, for pregnant high-risk patients with obstetric antiphospholipid syndrome, include oral hydroxychloroquine and intravenous immunoglobulin; however, further research is required in this area.

If someone with a history of thrombotic antiphospholipid syndrome (but not obstetric antiphospholipid syndrome) becomes pregnant, warfarin must be stopped as soon as possible (within the first 6 weeks of pregnancy) and replaced with a therapeutic dose of heparin. This is because of risks to the fetus, including teratogenicity and bleeding. Full-dose LMW heparin and low-dose aspirin are recommended for the duration of the pregnancy and for 6 to 12 weeks postpartum.