J Korean Med Sci.  2021 Jan;36(4):e24. 10.3346/jkms.2021.36.e24.

Management of Women with Antiphospholipid Antibodies or Antiphospholipid Syndrome during Pregnancy

• Lee EE
• Jun JK
• Lee EB

• KMID: 2510903
• DOI: http://doi.org/10.3346/jkms.2021.36.e24

Abstract

Antiphospholipid syndrome (APS), which is characterized by the presence of antiphospholipid antibodies (aPL), is associated with increased risk of thrombosis and obstetric complications, including preterm delivery and recurrent pregnancy losses. APS shows diverse clinical manifestations and the risk of complications varies among clinical subtypes. Although these patients are usually treated with aspirin and anticoagulants, the optimal treatment in various clinical settings is unclear, as the risk of complications vary among clinical subtypes and the management strategy depends on whether the patient is pregnant or not. Also, there are unmet needs for the evidence-based, pregnancyrelated treatment of asymptomatic women positive for aPL. This review focuses on the management of positive aPL or APS in pregnant and postpartum women, and in women attempting to become pregnant. For asymptomatic aPL positive women, no treatment, low dose aspirin (LDA) or LDA plus anticoagulants can be considered during antepartum and postpartum. In obstetric APS patients, preconceptional LDA is recommended. LDA plus low molecular weight heparin is administered after confirmation of pregnancy. Vascular APS patients should take frequent pregnancy test and receive heparin instead of warfarin after confirmation of pregnancy. During pregnancy, heparin plus LDA is recommended. Warfarin can be restarted 4 to 6 hours after vaginal delivery and 6 to 12 hours after cesarean delivery. Most importantly, a tailored approach and patient-oriented treatment are mandatory.

Keyword

Antiphospholipid Antibodies; Antiphospholipid Syndrome; Aspirin; Pregnancy

Figure

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  Fig. 1 Risk of venous thromboembolism in pregnant or postpartum women. Postpartum indicates first 6 weeks after delivery.

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  Fig. 2 Management of obstetric antiphospholipid syndrome with recurrent abortion.LMWH = low molecular weight heparin.aLow molecular weight heparin can be omitted in patients who have only history of placental insufficiency.

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  Fig. 3 Management of vascular antiphospholipid syndrome with recurrent abortion.LMWH = low molecular weight heparin.aTherapeutic dose.

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