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Antiphospholipid Syndrome — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeAntiphospholipid SyndromeSCE Rheumatology

A 36-year-old woman with obstetric APS (3 early pregnancy losses, positive anticardiolipin IgG and lupus anticoagulant) conceives again. She is on low-dose Aspirin and prophylactic LMWH. At 34 weeks she is doing well. When should LMWH be stopped?

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Correct answer: C — Before planned delivery or labour

LMWH should be discontinued at the onset of labour or 24 hours before planned delivery (induction or caesarean section) to reduce bleeding risk and allow epidural anaesthesia. Anticoagulation should be restarted postpartum (usually 6-12 hours after delivery for prophylactic dose) and continued for at least 6 weeks postpartum, as the puerperium is a high-risk period for thrombosis in APS. Aspirin can typically continue until delivery.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions