Life-threatening bleeding, pregnancy and lupus anticoagulant: success after steroid and anticoagulant therapy.
OBJECTIVE
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.


METHODS
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.
Department of Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 16297jar@comb.es
Jaume
J
Alijotas-Reig
Juan Carlos
JC
Ferrer-Raventos
D000328:Adult; D016736:Antiphospholipid Syndrome / Q000188:drug therapy* / Q000276:immunology; D001241:Aspirin / Q000494:pharmacology; D017984:Enoxaparin / Q000494:pharmacology*; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology*; D005938:Glucocorticoids / Q000494:pharmacology*; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000276:immunology*; D010743:Phospholipids / Q000627:therapeutic use; D011241:Prednisone / Q000494:pharmacology*; D011247:Pregnancy; D014592:Uterine Hemorrhage / Q000276:immunology / Q000517:prevention & control*
D017984:Enoxaparin; D005343:Fibrinolytic Agents; D005938:Glucocorticoids; D016682:Lupus Coagulation Inhibitor; D010743:Phospholipids; D001241:Aspirin; D011241:Prednisone