Protocol for treatment of antiphospholipid antibodies/antiphospholipid syndrome.
| Clinical History | Anticoagulant Therapy |
|---|---|
| No thrombosis, miscarriage, or adverse pregnancy outcome | Start aspirin 75 mg preconception |
| Previous thrombosis | |
| Previous venous events | Start aspirin 75 mg and LMWH (enoxaparin 40 mg, dalteparin 5000 IU) as soon as pregnancy confirmed and increase LMWH to BD at 16 weeks |
| Previous arterial events | Start aspirin 75 mg and LMWH (enoxaparin 40 mg, dalteparin 5000 IU) twice daily as soon as pregnancy confirmed. |
| Recurrent miscarriage < 10 weeks | |
| No anticoagulation | Start aspirin 75 mg preconception |
| Miscarriage on aspirin alone | Add LMWH OD once pregnancy confirmed. Considered discontinuing LMWH at 20 weeks’ gestation if uterine artery waveform normal |
| Late fetal loss, neonatal death or adverse outcome due to preeclampsia, FGR, or abruption | Start aspirin 75 mg preconception. Add LMWH OD once pregnancy confirmed and continue until term. |
LMWH: low molecular weight heparin; FGR: fetal growth restriction.