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Sunday, September 21, 2014
Lupus Anticoagulant and pregnancy
My doctor told me I tested positive for Lupus Anticoagulant. I have had two previous miscarriages and I am now pregnant again. My doctor has instructed me to take a childrens asprin every day of my pregnancy. She told me this would help to prevent miscarriage. According to my doctor, the Lupus Anticoagulant causes blood clots and the asprin will help with that . Do you now anything about this? What do you suggest?
Antiphospholipid antibodies are a group of antibodies that can be detected as "lupus anticoagulants" or "anticardiolipin antibodies". Lupus anticoagulants and anticardiolipin antibodies are detected using different laboratory techniques. Some patients can have both (70%), whereas some (30%) patients have one without the other. It is not clear whether lupus anticoagulant or anticardiolipin antibodies are more strongly associated with clinical complications.
In spite of the name (lupus anticoagulant) these antibodies can occur in people without lupus and they are "pro-coagulant" (tendency for clotting problems, blood clots). Women who have persistently elevated "lupus anticoagulant" or antiphospholipid antibodies tend to have pregnancy problems, particularly miscarriages. Patients who have persistent presence of these antibodies with multiple tests (there are several tests that are used to detect lupus anticoagulant) are more prone to clinical complications than patients who have transient positive antibodies.
Persistent presence of lupus anticoagulant-positivity and/or anticardiolipin antibody-positivity was associated with an increased risk of previous pregnancy loss. There are several approaches that have been used to prevent pregnancy problems in pregnant lupus patients with antiphospholipid antibodies. Also in general, pregnancy is a high risk period for clots. Therapies that have been evaluated include aspirin alone, aspirin plus prednisone, aspirin plus heparin (an injectable type of blood thinner) and heparin alone. Women with this problem should be followed by a team of high-risk ob/gyn, rheumatologist and in the coagulation clinic.
Yolanda Farhey, MD
College of Medicine
University of Cincinnati