Table 1

Factors of importance for risk assessment in obstetric APS and suggested treatments

Clinical/Serological manifestationsSuggested treatment
All carriers of significant aPL titres.Monitored in specialist maternity care units, if possible.
Screen for other CVD risk factors.
LDA if high-risk aPL profile.
Consider adding LMWH in risk situations such as presence of other CVD risk factors or immobility.
Patients with SLE diagnosis and positive aPL, but no previous thrombotic events or pregnancy morbidity.Hydroxychloquine+LDA.
Individual risk assessment depending on aPL profile, in some cases LMWH in prophylactic dose during pregnancy.
Previous early miscarriage and positive aPL.LMWH, prophylactic dose during pregnancy.
LDA.
Late fetal loss/pre-eclampsia/ IUGR and positive aPL.LMWH, intermediate or full therapeutic dose.
LDA.
Thrombotic APS.
Late fetal loss/pre-eclampsia/IUGR despite LMWH in prophylactic dose.
LMWH, intermediate or full therapeutic dose.
LDA.
Post partum.
All carriers of significant aPL titres.
During 6–12 weeks post partum:
Continue same treatment as during pregnancy.
If not given previously, consider adding LMWH to women with high thrombotic risk profile, for example, obesity-complicated delivery and so on.
  • aPL, antiphospholipid antibodies; APS, antiphospholipid syndrome; CVD, cardiovascular disease; IUGR, intrauterine growth restriction; LDA, low-dose aspirin; LMWH, low molecular weight heparin.