Life-threatening bleeding, pregnancy and lupus anticoagulant: Success after steroid and anticoagulant therapy

Problem: 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. Method of Study: 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 11 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.