Treatment of Antiphospholipid Syndrome in Women with Three or More Recurrent Miscarriages or Fetal Loss
This protocol covers the management of antiphospholipid syndrome (APS) in female patients who have experienced three or more recurrent spontaneous miscarriages before the 10th week of gestation, or fetal loss at or after the 10th week of gestation, and who have no history of thrombotic events.
Clinical scenario: Female patient with antiphospholipid syndrome and a history of recurrent pregnancy loss — either three or more early miscarriages (before 10 weeks) or at least one fetal loss (at or after 10 weeks) — with no prior thrombosis.
Management in this scenario involves a combination anticoagulant and antiplatelet approach, with one component initiated before conception and the other added once pregnancy is confirmed. Low molecular weight heparin forms part of the preferred approach. The full protocol details the specific agents, sequencing, and timing.
References
- With a history of ≥3 recurrent spontaneous miscarriages <10th week of gestation and in those with a history of fetal loss (≥10th week of gestation), combination treatment with LDA and heparin at prophylactic dosage during pregnancy is recommended.
- LDA should be preferably started prior to conception, and heparin (LMWH or UFH) should be added as soon as pregnancy is confirmed.
- LMWH is preferred for practical reasons.
DOI: 10.1136/annrheumdis-2019-215213
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