Get access

Life-Threatening Bleeding, Pregnancy and Lupus Anticoagulant: Success after Steroid and Anticoagulant Therapy

Authors


Address reprint requests to J. Alijotas-Reig, JMa de Segarra 2-F, 08190 Sant Cugat del Valles, Barcelona, Spain.
E-mail: 16297jar@comb.es; jalijotas@vhebron.net

Abstract

Problem:  The clinical manifestations associated with the presence of the lupus anticoagulant (LAC) are usually thrombotic and/or obstetric complications, specially miscarriages and/or repeated fetal deaths. The bleeding episodes in patients with LAC with no other coagulation disorders are exceptional, especially during pregnancy, intra- and postpartum.

Method of study:  Here we present two cases of patients with classification criteria of primary antiphospholipid antibody syndrome, a history of recurrent complicated pregnancies and massive bleeding during abortion and postpartum. We studied anticardiolipin (IgG/IgM), beta2glicoprotein-1 (IgG) and antimitochondrial (type 5) antibodies, LAC, rapid plasma reagin, coagulation test, clotting factors and, placental vascular flow from the second trimester of their last pregnancies.

Results:  LAC was repeatedly detected in both cases. The prothrombin time and clotting factors including factors II and XIII were normal. Intrauterine growth restriction was also observed in both patients. Pre-eclampsia was detected in patient 2. We tried enoxaparin (60–80 mg/day) and prednisone (1 mg/kg/day) therapy and no maternal, hemorrhagic or thrombotic episodes were observed.

Conclusions:  Exceptionally, LAC may be associated with recurrent, life-threatening bleeding, even in patients with no prothrombin deficiency. The close follow-up and early anticoagulant and steroid therapy seems to be able to control thrombotic and hemorrhagic complications during the pregnancy and postpartum.

Get access to the full text of this article

Ancillary