The Hemophilia and Thrombosis Center of Nevada

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Las Vegas, Nevada 89106

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since May 5, 2008

Last updated May 5, 2008

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PREGNANCY AND ANTICARDIOLIPIN ANTIBODIES

 

I am a 38 yr old female who is looking for some direction when considering whether or not I want to try to become pregnant.  10 yrs ago, had 4 miscarriages during a 2 year period.  These miscarriages varied between 8, 12, and 16 weeks.  After the forth miscarriage, I had several tests completed at the Baylor University facility in Houston and the only thing that they could tell me was that I had elevated levels of the anticardiolipn antibody in my system.  At that time, they really did not have a great deal of information on how to proceed. 

 

I have not attempted to become pregnant since that time and have also re-married during this 10 year period.  Now, between my age and the antibody, I am uncertain of how to approach this.  I've asked my regular ob/gyn and they were educated enough in this particular area to give me advice...who do I talk to? A fertility specialist? 

 

Any direction you can provide would be greatly appreciated.

Ronda

I would begin by speaking to a hematologist with expertise in clotting disorders.  He or she will probably recommend a high risk obstetrician that is experienced in this area.  Typically pregnant women are continued on low molecular weight heparin with or without aspirin to ensure that you go to term and deliver a healthy baby.

Be careful of any fertility drugs, especially hormones which may increase your risk of blood clots.

 

 

 

I am 30 year old, and I am 3,5 months pregnant of our 2nd child. The
pregnancy of our 1st child went well and I gave normal birth. With my first
pregnancy I had bleedings twice, but it turned out to be placenta previa
(fortunately the placenta went up in the 7th month).

I never had any miscarrage or problems getting pregnant. There are no cases
of hart attacks in my family. Still, somehow in the beginning of my second
pregnancy my obgyn let me check my Aca and it turned out like this: Aca IgG
9,9 and IGM 82,2.

Then he gave me aspillets twice a day (which I have been taken for a bout a
month now) Recently we checked again and it was IgG 9,975 and Aca IgM 47,
352. They say it is still to high and I should get injections everyday.

Now what will you usually do in my case and with my history? What kind of
medication? Are the injections every day really necessary or could I just
stay on aspillets? I really would like to know as soon as possible cause
this comming tuesday they want to know the answer if I want to go on with
the injections. Since I live in Indonesia, information is very rare about
this matter. Our insurance will not pay for the injections, and they are
really expansive. That is why I would really like a second opinion.

Thanks for your help, and thanx for having a website about ACA.

It is unclear why the tests were ordered in the first place and therefore the significance clinically is not known.  If you test normal blood donors, a portion will be positive for ACA however without a history of clotting, missed abortions, or low platelets there is no clinical significance or predictive capability as to whether there are problems expected in the future.  In addition, treatment is only indicated in those persons with ACA who have had difficulty attributable to this syndrome.  If a person tests positive and has never had a blood clot, no treatment is needed.  I would recommend that you speak to a high risk OB used to dealing with this disorder and also a hematologist to ensure that treatment is or is not needed.
 

 

 

Goodmorning.  I was diagnosed with anticardiolipin syndrome about 7 years ago.  I have 5 children in which 4 were carried with no difficulties.  With the last one (after confirming the diagnosis) I was on injections of heparin 2x day for the duration of the pregnancy.  At the time of the initial diagnosis they tested me right after a D&C from a failed pregnancy.  They decided to do the test because it was the second one in 6 months. The test came back that I had it but just barely.  My question is this.  How do I know if I have this on a permanent basis or if this is something that's just pregnancy induced?  Thanks so much for your time!
Take Care,
Teri

This is an excellent questions that I am not sure has a true answer.  This syndrome is poorly studied and so much of what we know is from large cohort studies, retrospective review of patient's charts, and testing of blood bank donors.  Therefore, the true incidence of the development or the significance in all patients who become pregnant is not known.  Nor is it known if this level waxes and wanes as we think, or eventually disappears after pregnancy.

Since persons with this antibody, unless related to the use of antibiotics, are commonly treated for it for life, I would err on the safe side and recommend that treatment if needed be continued with future pregnancies, and that you always take precautions to prevent the development of blood clots.  This includes early mobility after surgery, the use of heparin shots while immobilized, no use of hormones and walking and moving around on long flights or drives.  Hopefully with the current research push for persons with clotting disorders, answers will soon be forthcoming that will help you with your medical questions.

 

I am 33 years old and I have two children.  Before I had my children, I had two miscarriages.  After my second miscarriage, my OB/GYN ran some blood tests that revealed a borderline high anticardiolipin antibody.  Therefore, with both of my successful pregnancies, I took on e baby aspirin a day.  Then in April of 2002, I had a DVT in the right groin and a PE in the left pulmonary artery.  I was on Coumadin for 6 months and I had to take Lovenox as well for a couple of months.  I was taking 12.5 mg of Coumadin for quite some time, with m y INR still being subtherapeutic.  I was tested for many, many things that never explained the cause of the PE and the DVT.  My hematologist checked the anticardiolipin antibody and it was normal.  I have been told that if I have another pregnancy, I would need to take heparin throughout the pregnancy.

    My question is, do you think all of this is related?  Does the anticardiolipin antibody fluctuate?  What does this mean for an occurence of another clot?  How would I go about preventing further problems?

Shannon

The testing for anticardiolipin testing may be limited in that there are four antibodies, however standard testing can detect two, the anticardiolipin and antiphosphotidyserine antibodies.  There is also a test for the cofactor beta 2 glycoprotein I.  Some centers make their own mish mash testing that includes all four antibodies and may improve the yield of testing, however this is not standardized and therefore poses additional problems.  Therefore, it is first important to identify what testing you had obtained and the results.

In addition, the antibodies do fluctuate so it is important that you were tested on at least two occasions. 

Persons with this disorder typically have recurrent miscarriages which may be treated to improve the outcome of pregnancy and blood clots.  If blood clots occur and the antibody is present, long term therapy with blood thinners, warfarin, is indicated to prevent additional blood clots since the risk is so elevated in these persons.

We have found that it is difficult to regulate the warfarin in persons with this disorder and they must be followed closely, usually weekly, to achieve a therapeutic level.  Other tests may be of benefit in the regard.

Good luck

I was on my second pregnancy when I had a blood clot burst and I thought it was a miscarriage.  The doctors found out I had a blood clot attached to my placenta which eventually dissolved we think.  Then they told me on my third child I have anticardiolipin.  Am I supposed to be on medicine?  Will I eventually die withoug medicine because I do not have insurance.  Are there any symptoms other than blood clots?

Kim

In response to your questions. If you have had a blood clot in the lung, leg, arm, stroke, or heart attack, and have this antibody, then life long therapy with blood thinners are indicated to prevent additional blood clots which may be life threatening.

However, if you have had difficulty with pregnancy, and no other blood clots, then you will only require treatment during future pregnancies to allow for a normal delivery. During times of stress, such as surgery, you should receive blood thinners. Also, I would encourage you not to go on hormones of any type including birth control pills and avoid tobacco usage. These things may increase your risk of future problems.

Most areas have a public assistance hospital, usually at the university, where noone is denied care. I would encourage you to schedule an appointment at such a center to have the rest of your particular concerns addressed by a hematologist.


 

Hi,
I wish I would have found your web site a while ago. Thank you for expanding your support. I am a 37 year old female.  I have polycystic ovaries and took Clomid to help me ovulate in 1999. I got pregnant right away then developed an extensive DVT in my left leg and miscarried. I was diagnosed with anticardiolipin antibody syndrome, put on lovenox, then heparin and eventually just coumadin.  I was tested every 3 months for a year (2001) for the cardiopilin antibody (anticoagulant panel) and my levels were normal. I came off coumadin January 2002 and started the 81mg aspirin.  The doctor wants to test yearly using the same tests.  I am currently waiting on the results.  I want to try to get pregnant again and would like to know if I will need to take blood thinners during pregnancy if my levels are still normal.  If I have normal levels for 2 years does this decrease my chance of getting a blood clot ever again ( wishful thinking!)?  My doctor does not know if pregnancy increases the antibody or if the elevated antibody causes a miscarriage.  I would really appreciate any info you can give me.  Thank you.  Lisa

In response to your questions. We do not usually do research on pregnant women, therefore there is limited answers to your questions.

In the past, persons with ACA were placed on medication to result in a negative antibody test, However, they still had clotting episodes, therefore, normalization of this test is no longer a goal of therapy. Persons with the ACA and a blood clot are at extraordinary risk of recurrent clots and usually remain on lifelong anticoagulant medication to prevent addition adverse events. Aspirin is not as effective.

I assume your doctor thinks the antibody resulted from either the medication or the pregnancy. This is hard to prove.

WE have had many pregnancies in patients with this disorder. However, they must be monitored closely and heparin shots may improve the outcome resulting in a healthy baby. There is risk of blood clots to the mother but also blood clots in the supply of blood from the mother to fetus which may result in problems carrying to term and small birth weight babies.

I would recommend that prior to becoming pregnant you see a hematologist who specializes in clotting disorders and also a high risk obstetrician in consultation. This will help answer your specific questions.

Hello,
I am a 33-year-old mother of a 2 1/2 year old little boy.  This past year I experienced two 1st trimester miscarriages within 6 months of each other.  Recently I was diagnosis with two positive tests for the anitcardiolipin antibody.  My question is if this is at all related from taking birth control pills.  Prior to conceiving my son I had been on the pill for 10 years straight.  I know that one of the many side effects of taking the birth control pill could be blood clots. 
Just wondering if there were any connection between the two?

The cause of the anticardiolipin antibody is not known.  It has been linked to antibiotic therapy, however this does not usually result in blood clots, only a positive test.

Birth control pills are associated with blood clots as the hormones increase the bodies propensity to form blood clots.  Your development of this syndrome cannot be linked to any medication that you took previously. 

The anticardiolipin antibody syndrome is associated with recurrent miscarriages.  Therefore, this may be related to your past experience.

Hi.

I am a 40 year old women pregnant for the second time with In-vitro
and I have been told that I have an anticardiolipin antibody.  The
first time I was pregnant at the age of 37, in the beginning of my
2nd trimester, a blood test was taken and was discovered that I have
AA.  Was a huge confusion weather to take heparin or not considering
I have no record of a miscarriage or a blood clot.  My obgyn decided
to give me heparin as well as a baby aspirin for the remainder of my
pregnancy.  I delivered a healthly baby.

As I mention, I am now 6 weeks pregnant and my infertility specialist
doesn't think I need heparin right now.  He claims if I was going to
get a clot, I would have already done so;I tend to disagree
considering what I understand and what I've   been through.  I have
been through a tremendous amount of pain and medical and financial
grief and want to do everything in my power to save this fetus.

By taking heparin even when not needed, is it dangerous to me or my baby?
How can I tell if I have a blood clot?

My AA Blood test results before pregnancy are:
  Cardiolipin AB-IGG      25
  Cardiolipin AB-IGM      44

Thank you so much for you time.

Laura


First, the risk of a blood clot peaks toward the end of pregnancy and lasts up to six weeks after delivery. Therefore, just because you are not on heparin and have not yet had a blood clot does not mean that you are no longer at risk.

Heparin, while never studied for use in pregnant women has a longstanding track record with no evidence of problems in the mother or fetus. I would have no concern regarding it's use. IT must be discontinued at least 24 hours before epidural anesthesia, therefore, some women prefer to be induced.

It is well known that in persons with one blood clot who have the ACA testing positive on two occasions, they are at increased risk of additional blood clots. However, since we do not usually test persons for this who have never had a blood clot, there is no information as to how many pregnant women may test positive and have no problems. Therefore, there is no answer to whether you should or should not be on heparin. There is a study in women in Canada who have had one clot during pregnancy. They were followed to see if they developed another clot during subsequent pregnancies, although they excluded persons with ACA, and found that many did not, and were safe off of heparin. Whatever you decide, since there is no correct answer, you must be followed closely and be cognizant of the symptoms of blood clots.

Best of luck to you. Please keep us posted as to how you do, and I would also encourage you to participate in our database as that is how we will ultimately come up with the correct answers to questions such as yours, through well designed medical research.

 

I was told by my doctor that my miscarriages were caused by anticardiolipin.   I am now scared to get pregnant.  Should I take a baby aspirin everyday of my life?  Does pregnancy increase the chances of having a blood clot?

While you do not give details of your condition, the literature supports testing for coagulation abnormalities in patients that have had recurrent miscarriages depending upon when in the pregnancy these have occured. While noone can prove that the anticardiolipin antibody causes the miscarriage, there is an association in some people. There is much literature on patients who become pregnancy with this condition and the use of heparin products to improve the likelihood of a normal pregnancy and healthy baby. A high risk obstetrician should be consulted prior to your deciding to become pregnant again.

In patients with the anticardiolipin antibody who have never had a blood clot, they may not be at a marked increase risk to cause a blood clot, however they should be watched carefully to ensure this does not occur and if it does, that treatment is available immediately.

Aspirin may be better than nothing but is probably NOT protective enough to recommend for this reason.

I would recommend that you consult a coagulation specialist in your area to discuss this further and a high risk obstetrician that has experience with this to ensure that you are able to have a healthy family in the future.

 

I had a dvt and pe during my 5th pregnancy. I was on lovenox and now on
coumadin. I had a greenfield filter inserted at 12 wks preg. I was told
I had a positive lupus anticoagulant during the pregnancy(drawn while on
a heparin infusion), and a prothrombin gene defect. I delivered a
healthy baby one year ago. Will I ever be able to know for sure if I
have antiphospholipid syndrome because I must take coumadin? I have been
to several specialists and none have suggested following up on it and I
never really wanted to know. Do you think it is important to pursue this
and can you give me more information on prothrombin gene defect? I am a
critical care nurse and would appreciate any information. Thank you
 

Thank you for logging onto our web site.

Under clotting disorders on the web site, you will find information regarding the different clotting abnormalities and their usual treatment.

As for the lupus anticoagulant, this is treated differently according to guidelines. A higher INR is required to prevent recurrent clot, usually between 2.5 and 3.5. Therefore, confirmation of this abnormality is needed. The testing for the antibody, which includes anticardiolipin antibody, beta 2 glycoprotein I (a cofactor) and sometimes antiphospholipid antibody (although not uniformly accepted) may be done while on heparin and/ or coumadin. The clotting tests must be done off of warfarin. If the antibody tests are negative, you can go on Low molecular weight heparin for two weeks, have the lab repeated and then resume warfarin. I would recommend testing only because the treatment differs.

You do not mention why a filter was placed or if this was your first blood clot. If this was a first blood clot and you have a lupus anticoagulant, long term anticoagulant therapy is needed. However, if you have had only one blood clot and have only a heterozygote defect of the prothrombin gene mutation, long term treatment may or may not be indicated. We don't have enough data at present.

I would recommend you be evaluated by a clotting specialist who is familiare with this. I would also refer you to the Chest Supplement from January 2002 and also proceedings from the annual meeting of the Internationsl Society of Thrombosis and Hemostasis published as an abstract to Thrombosis and Hemostasis every other year. This provides up to date information regarding this disorder and usually provides a section on pregnancy.

Best wishes.

 

 

 

 

 

 

 

 

 

 

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Last modified: March 02, 2008