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Re: Lupus anticoagulant and pregnancyFrom: Laifer, Dr. Steven (pslaif@bpthosp.chime.org)Wed Jul 30 13:25:54 1997
>The question is, in light of her lab abnormalities should she be considered >for Heparin and/or steroid administration. My tendency is to not treat >based solely on lab data, and since her first pregnancy proceeded without >hypertension, IUGR, etc., I have every reason to expect no different this >gestation. Doug: I'm assuming the diagnosis of LAC is based on those abnormal clotting studies after mixing with normal plasma. Does your patient have any clinical features (not pregnancy related) that would support the diagnosis of antiphospholipid syndrome i.e., thrombosis, thrombocytopenia, livedo reticularis? I would personally offer her the option of heparin therapy in addition to baby aspirin ( I prefer low molecular weight heparin, if her carrier will reimburse), though clearly her prior pregnancy outcome was favorable. I no longer offer steroids based on literature that suggests excessive risks of PTD. Recent references of interest on antiphospholipid syndrome and pregnancy: JAMA 5-21-97 pp 1549-1551 Rheumatic disease clinics of NA; February 1997 Best Wishes. Steven Laifer MFM Bridgeport, CT
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