A 34-year-old woman with SLE and a history of two first-trimester miscarriages tests positive for lupus anticoagulant and anticardiolipin IgG on two occasions 12 weeks apart. She is now 8 weeks pregnant. According to current EULAR guidelines, the recommended prophylactic regimen is:
- A Low-dose aspirin plus low-molecular-weight heparin throughout pregnancy ✓
- B Low-dose aspirin alone
- C Warfarin throughout pregnancy
- D Hydroxychloroquine alone
Explanation
Antiphospholipid syndrome (definite, given two positive tests 12 weeks apart plus obstetric criteria of ≥2 miscarriages) in pregnancy requires combination prophylaxis with low-dose aspirin (75–100 mg/day) plus low-molecular-weight heparin (prophylactic or intermediate dose); this combination has been shown to increase live birth rates significantly. Warfarin crosses the placenta and is teratogenic in the first trimester. Aspirin alone is inferior to combination therapy for this high-risk profile. Hydroxychloroquine is continued for SLE control but does not substitute for antithrombotic prophylaxis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.