Antiphospholipid synd: Mgmt in labor

Antiphospholipid syndrome describes an acquired autoimmune disorder characterized by venous and/or arterial thromboses as well asrecurrent pregnancy loss. This syndrome may occur secondarily to autoimmune disorders such as systemic lupus erythematosus or rheumatoid arthritis, or it may occur in isolation. Characteristically, antiphospholipid syndrome results in mild prolongation of the aPTT and positive testing for lupus anticoagulant or anticardiolipin antibodies. Despite the prolonged aPTT, antiphospholipid syndrome poses no increased bleeding risk but rather increases the potential for thrombosis. Antibodies associated with antiphospholipid syndrome interfere with phospholipids common to many laboratory-based tests of coagulation. Isolated prolongation of an aPTT in a preoperative patient merits consideration of the diagnosis of antiphospholipid syndrome. Patients with this syndrome who have experienced a thrombotic complication are at increased risk for recurrent thrombosis and most often are managed by life-long anticoagulation.As patients with antiphospholipid syndrome are frequently treated with anticoagulants, neuraxial anesthesia may be contraindicated. That said, “In the absence of coagulation defects secondary to clotting factor antibodies or platelet abnormalities, the in vitro phenomenon of prolonged aPTT alone should not, in theory, predispose to hemorrhage or be a contraindication to epidural anesthesia in [these] patients.”atients require close monitoring for both bleeding and thromboembolic complications postoperatively.