When do you initiate enoxaparin (Low Molecular Weight Heparin) for antiphospholipid syndrome in pregnancy?

From the Guidelines

For antiphospholipid syndrome (APS) in pregnancy, low molecular weight heparin (LMWH) such as enoxaparin should be started as soon as pregnancy is confirmed, ideally before 6 weeks gestation, in combination with low-dose aspirin, for patients meeting criteria for obstetric APS (OB APS) 1. The typical regimen is prophylactic enoxaparin 40mg subcutaneously once daily, though higher doses may be needed for patients with previous thrombosis (therapeutic dosing at 1mg/kg twice daily) 1. Some key points to consider when initiating enoxaparin for APS in pregnancy include:

• The importance of early initiation, as APS increases the risk of early pregnancy loss, preeclampsia, intrauterine growth restriction, and thrombosis 1
• The need for combination therapy with low-dose aspirin (81-100mg daily), which is often started preconception 1
• The requirement for treatment to continue throughout pregnancy and for 6 weeks postpartum due to increased thrombotic risk during this period 1
• The potential need for dosage adjustments based on weight changes during pregnancy or anti-Xa levels in certain cases 1
• The importance of regular monitoring with a maternal-fetal medicine specialist throughout pregnancy 1 It is essential to note that the decision to initiate enoxaparin should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history, and that the benefits of therapy should be weighed against the potential risks 1.

From the Research

Initiation of Enoxaparin in Antiphospholipid Syndrome during Pregnancy

• The management of antiphospholipid syndrome (APS) during pregnancy involves preventing thrombotic events and pregnancy morbidity 2.
• According to the available evidence, low molecular weight heparin (LMWH) and aspirin are recommended for use during pregnancy in APS patients 3.
• The specific timing of initiation of enoxaparin, a type of LMWH, is not explicitly stated in the provided studies.
• However, it is recommended that women with APS during pregnancy should be under the care of obstetricians and physicians specialising in APS, and that treatment should be individualized based on the patient's risk factors and medical history 3.
• In general, anticoagulation therapy, including LMWH, is typically initiated early in pregnancy, often as soon as the pregnancy is confirmed, in women with a history of thrombosis or pregnancy morbidity due to APS 2.

Key Considerations

• The use of enoxaparin in APS patients during pregnancy is aimed at preventing thrombotic events and improving pregnancy outcomes 2.
• The management of APS during pregnancy requires a multidisciplinary approach, involving obstetricians, physicians, and other healthcare professionals 3.
• The treatment regimen should be individualized based on the patient's risk factors, medical history, and current clinical guidelines 2, 3.