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Obstetric APS Treatment — RACP Adult Medicine MCQ

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ModerateRheumatologyObstetric APS TreatmentRACP Adult Medicine

A 40-year-old woman with SLE presents with recurrent pregnancy loss (3 first-trimester miscarriages). She has no history of thrombosis. Her lupus anticoagulant is positive on two occasions 14 weeks apart. Anti-cardiolipin and anti-beta-2 glycoprotein I antibodies are also positive (triple positive). During her next pregnancy, what treatment regimen is recommended?

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Correct answer: C — Low-dose aspirin plus prophylactic-dose LMWH (enoxaparin 40 mg daily)

For obstetric APS (recurrent pregnancy loss with persistent antiphospholipid antibodies but no prior thrombosis), the standard treatment during pregnancy is low-dose aspirin (commenced pre-conception or early first trimester) PLUS prophylactic-dose LMWH (enoxaparin 40 mg SC daily). This combination significantly improves live birth rates from ~10% to ~70%. Warfarin is teratogenic (particularly weeks 6–12 – warfarin embryopathy) and is CONTRAINDICATED in the first trimester. Hydroxychloroquine may provide additional benefit and should be continued. Triple-positive APS carries the highest thrombotic risk.

Reference: eTG – 2025 – Haematology; EULAR – 2019 – APS Pregnancy Recommendations