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Budd-Chiari Syndrome, Systemic Lupus Erythematosus, and Secondary Antiphospholipid Antibody Syndrome in Pregnancy

Joffe, Gary M. MD1; Aisenbrey, Gary A. MD; Argubright, Kent F. MD1

Case Reports

BACKGROUND: Hypercoaguable states such as the antiphospholipid antibody syndrome may be associated with thromboses in any vascular bed.

CASE: This case report demonstrates clinical manifestations of Budd-Chiari syndrome during pregnancy, diagnostic dilemmas, and suggestions for prevention of serious thromboembolic complications.

CONCLUSION: Patients with antiphospholipid antibody syndrome and previous thromboses in any vascular bed who are considering pregnancy should be considered candidates for full anticoagulation throughout the entirety of gestation and the puerperium. Anti-Xa levels may reflect inadequate dosing of low molecular weight heparin, particularly during the first trimester, and should be monitored frequently. In patients with suspected hepatic venous thrombosis, Doppler evaluation may be inadequate to establish the diagnosis.

A pregnant woman with systemic lupus erythematosus and secondary antiphospholipid antibody syndrome presented with thrombosis in an unusual vascular bed while receiving enoxaparin.

From 1Perinatal Associates of New Mexico, Albuquerque, New Mexico.

Corresponding author: Gary M. Joffe, MD, Perinatal Associates of New Mexico, 201 Cedar, SE, Suite 405, Albuquerque, NM 87106; e-mail: gjoffe1@comcast.net.

© 2005 The American College of Obstetricians and Gynecologists