Management of Recurrent Miscarriage with Suspected Lupus Anticoagulant

Diagnostic Approach

The International Society on Thrombosis and Haemostasis recommends repeat lupus anticoagulant testing after 12 weeks is mandatory before making any definitive diagnosis of antiphospholipid syndrome, as transient positivity is common and false-positives occur frequently 1, 2, 3
The American College of Obstetricians and Gynecologists suggests that anticardiolipin antibodies (IgG and IgM) and anti-β2-glycoprotein-I antibodies (IgG and IgM) must be measured if not already done 1, 2
The patient has "moderate" risk criteria for APS (recurrent spontaneous early pregnancy loss), making LA testing appropriate 1, 2, 3

The European League Against Rheumatism recommends treating with combined low-molecular-weight heparin (LMWH) and low-dose aspirin throughout pregnancy, as this combination reduces pregnancy loss and thrombosis in pregnant patients with SLE and antiphospholipid syndrome 4, 5
The American College of Cardiology suggests that low-dose aspirin (75-100 mg daily) should be started preconceptionally or as soon as pregnancy is confirmed 4, 5
The International Society on Thrombosis and Haemostasis recommends that LMWH (enoxaparin 40 mg daily or equivalent) should be started when pregnancy is confirmed 4, 5

The American College of Obstetricians and Gynecologists advises against diagnosing APS based on single positive test - confirmation at >12 weeks is mandatory to avoid false-positive results that are "relatively common" 1, 2, 3
The European League Against Rheumatism suggests that testing should be done off anticoagulation - anticoagulants interfere with LA assays 1, 2
The American Heart Association recommends against using aspirin alone - combination therapy with LMWH is required for obstetric APS 4, 5