Clinical/Serological manifestations | Suggested 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.