How should a pregnant patient with a history of thrombosis be managed in relation to APLAS?

Management of a pregnant patient with a history of thrombosis, particularly in relation to Antiphospholipid Syndrome (APS), often necessitates more than just conservative measures or lifestyle modifications. Patients with APS are at a significantly increased risk for both venous and arterial thrombotic events, especially during pregnancy.

Starting lifelong anticoagulation or initiating prophylaxis with heparin is crucial in managing these patients. Heparin, particularly low molecular weight heparin (LMWH), is the treatment of choice during pregnancy as it effectively reduces the risk of thrombosis while being safe for the developing fetus. The use of heparin is preferred over other anticoagulants due to its ability to prevent placental insufficiency and other complications associated with APS, such as recurrent miscarriages or severe preeclampsia.

In cases where a woman has had a previous thrombotic event, maintaining anticoagulation helps mitigate the potential for further incident occurrences during the pregnancy. Thus, the correct approach in managing a pregnant individual with a history of thrombosis related to APS is to either continue lifelong anticoagulation or start prophylaxis with heparin to ensure both maternal and fetal wellbeing.