Hemorrhagic complication of anticoagulation during pregnancy in a woman with lupus anticoagulant.
BACKGROUND
Lupus anticoagulant is an acquired antiphospholipid antibody that can increase greatly the risk of thromboembolism during pregnancy. Because a baseline elevated activated partial thromboplastin time (PTT) is associated frequently with this antibody, monitoring anticoagulant effect with activated PTT can be unreliable.


METHODS
A pregnant woman with lupus anticoagulant being treated with adjusted dose heparin experienced concurrent severe thrombotic and hemorrhagic complications.


CONCLUSIONS
This case illustrates the pitfall of activated PTT monitoring when administering anticoagulation therapy to a patient with a baseline elevated activated PTT. We propose that heparin levels be used to monitor anticoagulation in these patients.
Casele
H L
HL
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, Pennsylvania, USA. hcasele@mem.po.co
Laifer
S A
SA
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006406:Hematoma / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood*; D010314:Partial Thromboplastin Time; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control*; D011655:Pulmonary Embolism / Q000517:prevention & control*; D013927:Thrombosis / Q000139:chemically induced*
D000925:Anticoagulants; D016682:Lupus Coagulation Inhibitor; D006493:Heparin