SHM Converge Scientific Abstract ePoster Gallery-Management of Probable Thrombotic Antiphospholipid Syndrome in Pregnancy

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This case report describes the management of probable thrombotic antiphospholipid syndrome (APS) during pregnancy. APS is an autoimmune hypercoagulable disorder caused by antiphospholipid antibodies such as anticardiolipin, anti-beta-2 glycoprotein I, and lupus anticoagulant, which promote thrombosis by interfering with anticoagulation, complement regulation, and fibrinolysis. In pregnancy, APS can also damage the placenta through inflammatory and complement-mediated effects on trophoblasts.<br /><br />A 20-year-old pregnant woman at 25 weeks presented with left femoral deep vein thrombosis (DVT) and was started on enoxaparin. Workup showed prolonged aPTT and DRVVT that corrected with mixing, but anticardiolipin IgG and anti-beta-2 glycoprotein I IgG were elevated. Eight weeks later, despite reported adherence to enoxaparin, she developed a right femoral DVT. Anti-factor Xa levels were checked and found to be subtherapeutic, indicating inadequate anticoagulation. Her enoxaparin dose was increased, after which anti-factor Xa levels became therapeutic. She ultimately delivered a healthy infant at 39 weeks without complications.<br /><br />The report emphasizes that APS diagnosis and management can be challenging, especially in pregnancy. High-risk APS includes lupus anticoagulant or double antibody positivity. Standard coagulation tests such as PT and aPTT may be unreliable, so anti-factor Xa monitoring is more useful for assessing heparin therapy in pregnant patients. Anticoagulants without anti-complement effects, such as fondaparinux, and direct oral anticoagulants are generally avoided in pregnancy. The case highlights the importance of individualized anticoagulation and close monitoring to prevent maternal and fetal complications.

Asset Subtitle

Eric Chan

Meta Tag

Author List Eric Chan, Kengo Z. Soghoyan, Margaret Beliveau, Mohammad Ishaq, Sonali W. Paul

Category Clinical Vignettes

Concept Antiphospholipid Antibody Syndrome

Concept Antiphospholipid Antibody

Concept Obstetric Antiphospholipid Syndrome

Concept Low Molecular Weight Heparin

Concept Thrombosis

Distinguished Non-Finalist

Presenter Organization Indiana University

Presenting Author Eric Chan

Track Adult

Keywords

antiphospholipid syndrome

pregnancy

deep vein thrombosis

enoxaparin

anti-factor Xa

lupus anticoagulant

anticardiolipin antibodies

beta-2 glycoprotein I

hypercoagulable disorder

thrombosis

Antiphospholipid Antibody Syndrome

Antiphospholipid Antibody

Obstetric Antiphospholipid Syndrome

Low Molecular Weight Heparin

Thrombosis