From the Guidelines
For pregnant women with antiphospholipid syndrome (APS), 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, as recommended by the 2020 American College of Rheumatology guideline 1. The typical regimen includes prophylactic-dose enoxaparin (40mg subcutaneously once daily) plus low-dose aspirin (81-100mg daily).
- For women with a history of thrombosis or recurrent pregnancy losses, therapeutic-dose enoxaparin may be used (1mg/kg twice daily or 1.5mg/kg once daily) 1.
- Treatment should continue throughout pregnancy and for 6 weeks postpartum due to increased thrombotic risk during this period, as supported by the guideline 1. Some key points to consider:
- Dosage adjustments may be needed as pregnancy progresses due to changes in blood volume and renal clearance.
- Early initiation is crucial because APS increases risks of recurrent miscarriage, preeclampsia, intrauterine growth restriction, and thrombosis.
- The anticoagulant prevents placental thrombosis and improves placental perfusion, while aspirin helps reduce inflammation and improves blood flow to the developing placenta. It is essential to weigh the potential risks and benefits of this therapy, particularly in individual high-risk circumstances, such as triple-positive aPL or strongly positive LAC results, advanced maternal age, or IVF pregnancy, and decisions should be made with discussion between physician and patient 1.
From the Research
Initiation of Enoxaparin in Antiphospholipid Syndrome during Pregnancy
- Enoxaparin, a low molecular weight heparin (LMWH), is used in the management of antiphospholipid syndrome (APS) during pregnancy to prevent thrombotic events and pregnancy morbidity 2, 3.
- The initiation of enoxaparin in APS during pregnancy is typically recommended as part of a treatment regimen that includes low-dose aspirin 2, 3.
- The specific timing of enoxaparin initiation is not universally agreed upon, but it is often started early in pregnancy, particularly in patients with a history of thrombosis or pregnancy morbidity 3.
- In patients with APS, enoxaparin is often initiated at the time of pregnancy confirmation, or even pre-conception, in order to reduce the risk of thrombotic events and pregnancy complications 2, 3.
- The use of enoxaparin in APS during pregnancy is supported by studies that demonstrate its effectiveness in reducing the risk of thrombotic events and improving pregnancy outcomes 4, 2, 3.