RPL with APS: When to Start RX

Dr. Chapa’s Clinical Pearls.

The SMFM, ACOG and RCOG all recommend screening for Antiphospholipid Antibody Syndrome (APS) in women with Recurrent Pregnancy Loss (RPL). However, once identified, there has been controversy historically regarding the best TIME to initiate low dose aspirin and prophylactic LMWH. The main controversy regarding this is whether to begin treatment before a confirmed pregnancy, right after a positive pregnancy test, or only after an ultrasound confirms a viable fetus; with some studies suggesting potential benefits from starting earlier, while others debate the optimal timing due to lack of conclusive evidence and potential risks associated with early anticoagulation. Nonetheless, we DO HAVE current guidance here to make an evidence-based plan of care for these patients. In this episode, we will summarize a recent Clinical Expert Series from the ACOG (May 2024) and the RCOG (June 2023). PLUS, we will highlight some persistent controversies surrounding APS and RPL.