In a pregnant patient with antiphospholipid antibodies, what is the recommended management if persistence is confirmed

• A. Do Nothing
• B. Stop Anticoagulation
• C. Start LMWH and Aspirin
• D. Abort the Pregnancy

Answer: (C)

Persistent antiphospholipid antibodies in pregnancy signal obstetric antiphospholipid syndrome, which raises the risk of placental thrombosis, miscarriage, fetal growth restriction, and maternal thrombotic events. The goal is to prevent clotting that can compromise the placenta and pregnancy. Low-dose aspirin helps by reducing platelet activation and improving placental blood flow, while therapeutic-dose low-molecular-weight heparin provides anticoagulation without crossing the placenta. Using both during pregnancy has been shown to improve obstetric outcomes and reduce maternal complications, and is continued through the postpartum period. Therefore, starting both LMWH and aspirin is the recommended approach when persistence is confirmed. Stopping anticoagulation or doing nothing would leave the patient at high risk, and abortion is not the standard preventive strategy for APS management in an otherwise viable pregnancy.