Here’s how readers responded to a You Make the Call question about treatment of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome.
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The patient should be on low-dose heparin until delivery.
Aubrey A. Lurie, MD
Overton Brooks VAMC
Due to the positivity of the lupus anticoagulant test and risk factors, the patient should receive anticoagulation with enoxaparin. In addition, a new determination of lupus anticoagulant, anticardiolipin, and anti-β2GPI antibodies should be made in 12 weeks.
Flor Armillas, MD
Instituto Nacional De Ciencias Médicas y Nutrición Salvador Zubirán
Mexico City, Mexico
I would also use a prophylactic dose of enoxaparin sodium.
Sajida Kazi, MBBS, FRCPath, MRCP
University Health Network
Roberto Velazquez, MD
Ponce, Puerto Rico
There are some pieces of the puzzle missing in the information provided. Did she have any history of thrombosis or prior miscarriages? How severe is her thrombocytopenia due to HELPP?
In a 31-year-old female that has at least three potential hypercoagulable problems (pregnancy, HELLP syndrome and (+) lupus anticoagulants), I would recommend subcutaneous enoxaparin 40 mg daily for the rest of her pregnancy, as opposed to aspirin alone.
The tricky part is how to do this based on her platelet count. If her thrombocytopenia due to HELPP is severe, it may pose a safety concern.
Alejandro Calvo, MD, FACP
Kettering Cancer Center
Yes, she should be on enoxaparin sodium.
Vinod K. Bhuchar, MD
I would switch aspirin to once-daily enoxaparin sodium at a prophylactic dose. Use unfractionated heparin near term with postdelivery prophylactic enoxaparin if she delivers via C-section.
Juan M. Alcantar, MD
Since she has had no loss of prior pregnancy and no thrombosis, low-dose aspirin alone is acceptable.
San Juan VA Medical Center
Rio Piedras, Puerto Rico