Address for correspondence: Munther A. Khamashta, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, London SE1 7EH, UK. Voice: +20-76202567; fax: +20-76202658. munther.khamashta{at}kcl.ac.uk
Pregnancy is a high risk period for thrombosis in women with
antiphospholipid syndrome (APS) and systemic lupus erythematosus
(SLE) with antiphospholipid antibodies (aPL). Thrombosis may
affect the mother, both in the venous and arterial beds, and
also have a role in pregnancy loss. Thromboprophylaxis thus
is warranted in most of these women. However, specific regimens
containing low-dose aspirin, unfractionated heparin (UH), low
molecular weight heparin (LMWH), and even dicumarinics in some
circumstances after the first trimester are still a matter of
controversy. Women with previous thrombosis should receive full
antithrombotic doses of UH or LMWH during the whole pregnancy.
Treatment of pregnancy losses is more debated, consisting of
low-dose aspirin with or without associated heparin. The choice
of treatment for a given patient must always take into account
the woman's opinion after a careful discussion with the treating
physician. Peripartum thromboprophylaxis with LMWH in women
receiving aspirin-only regimens and prevention of osteoporosis
in those treated with heparin are considered essential in the
medical management of these patients.
