Lupus anticoagulant

Background

Misnomer as it is a prothrombotic agent in-vivo (anticoagulant in-vitro in the lab)
Most patients do not actually have SLE (small proportion develop disease), but SLE patients more likely to develop lupus anticoagulant
Included in antiphospholipid syndrome (APS), where there are directed antibodies against membrane anionic phospholipids, or their associated plasma proteins
- Increases aPTT

Clinical Features

Recurrent arterial/venous thromboembolism
Recurrent fetal loss

Differential Diagnosis

Coagulopathy

Platelet Related

Too few
- Thrombocytopenia
Nonfunctional
- Aspirin
- Von Willebrand disease

Factor Related

Acquired (Drug Related)
- Warfarin (Coumadin)
- Unfractionated heparin
- Low molecular weight heparin (i.e. enoxaparin (Lovenox), dalteparin)
- Factor Xa Inhibitors (e.g. rivaroxaban, apixaban, fondaparinux, edoxaban)
- Direct thrombin inhibitors (e.g. dabigatran, argatroban, bivalirudin)
Illness induced
- Vitamin K deficiency
- Disseminated Intravascular Coagulation (DIC)
- Liver disease induced coagulopathy
- Uremic bleeding syndrome
Genetic

Evaluation

Management

Thrombosis (e.g. extremity phlebitis or dural sinus vein thrombosis)
- Heparin IV/SQ followed by warfarin +/- ASA
- Goal INR
  - Venous 2.0-3.0
  - Arterial 3.0
  - Recurrent 3.0-4.0

Pregnancy

Miscarriage is common

Prophylaxis for most women
Patients with pregnancy loss
- Prophylactic heparin and low-dose ASA
Patients with history of thrombosis
- Therapeutic heparin

Prophylaxis

Eliminate risk factors (OCPs, smoking, hypertension and HL)
Low-dose ASA

Disposition

See Also

Coagulopathy (Main)

References

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