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APS Pregnancy Anticoagulation — ESENeph MCQ

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ModeratePregnancy & RenalAPS Pregnancy AnticoagulationESENeph

A 30-year-old woman with antiphospholipid syndrome and CKD G3b from APS nephropathy asks about pregnancy planning. She is on Warfarin for recurrent thrombosis. What anticoagulation change is needed for pregnancy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Switch to therapeutic-dose LMWH before conception or as soon as pregnancy is confirmed

Warfarin crosses the placenta and is teratogenic (warfarin embryopathy: nasal hypoplasia in first trimester; CNS abnormalities throughout; fetal haemorrhage). Women on Warfarin for APS who plan pregnancy should switch to therapeutic-dose LMWH (e.g. Enoxaparin) before conception or as soon as pregnancy is confirmed. Low-dose Aspirin (75-150 mg) should be added from 12 weeks for pre-eclampsia prevention. DOACs are also teratogenic and contraindicated. Anticoagulation should be managed by a specialist obstetric/haematology team.

Reference: https://guidelines.ukkidney.org