APS Pregnancy Anticoagulation — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeAPS Pregnancy AnticoagulationSCE Rheumatology

A 38-year-old woman with primary APS (no SLE) on Warfarin for prior DVT asks about pregnancy planning. What anticoagulation modification is needed for pregnancy?

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Correct answer: A — Switch Warfarin to therapeutic-dose LMWH before conception (or as soon as pregnancy confirmed) plus low-dose Aspirin as Warfarin is teratogenic in the first trimester

Warfarin is teratogenic in the first trimester (chondrodysplasia punctata nasal hypoplasia CNS abnormalities) and should be switched to therapeutic-dose LMWH (weight-adjusted twice daily) before conception or as soon as pregnancy is confirmed. Low-dose Aspirin should be co-prescribed from pre-conception. LMWH is continued throughout pregnancy and should be stopped at delivery (as per obstetric guidance). Warfarin can be resumed postpartum as it is compatible with breastfeeding. DOACs are contraindicated in pregnancy. Close monitoring of anti-Xa levels is recommended to ensure adequate LMWH dosing.

Reference: EULAR 2019 APS recommendations; RCOG Green-top Guideline 37a