Lupus anticoagulant: Difference between revisions
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==Background== | ==Background== | ||
*Misnomer as it is a prothrombotic agent in-vivo (anticoagulant in-vitro in the lab) | *Misnomer as it is a prothrombotic agent in-vivo (anticoagulant in-vitro in the lab) | ||
*Most | *Most patients do not actually have [[SLE]] (small proportion develop disease), but SLE patients more likely to develop lupus anticoagulant | ||
*Included in | *Included in [[antiphospholipid syndrome]] (APS), where there are directed antibodies against membrane anionic phospholipids, or their associated plasma proteins | ||
**Increases aPTT | **Increases aPTT | ||
==Clinical Features== | ==Clinical Features== | ||
*Recurrent [[arterial thrombosis|arterial]]/[[venous thrombosis|venous thromboembolism]] | |||
*Recurrent [[miscarriage|fetal loss]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Increased bleeding DDX}} | {{Increased bleeding DDX}} | ||
== | ==Evaluation== | ||
==Management== | ==Management== | ||
*Thrombosis ( | *Thrombosis (e.g. extremity [[phlebitis]] or dural [[sinus vein thrombosis]]) | ||
**Heparin IV/SQ followed by warfarin +/- ASA | **[[Heparin]] IV/SQ followed by [[warfarin]] +/- [[ASA]] | ||
**Goal INR | **Goal INR | ||
***Venous 2.0-3.0 | ***Venous 2.0-3.0 | ||
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===Pregnancy=== | ===Pregnancy=== | ||
''Miscarriage is common'' | ''[[Miscarriage]] is common'' | ||
*Prophylaxis for most women | *Prophylaxis for most women | ||
*Patients with pregnancy loss | *Patients with pregnancy loss | ||
**Prophylactic heparin and low-dose ASA | **Prophylactic [[heparin]] and low-dose [[ASA]] | ||
*Patients with history of thrombosis | *Patients with history of thrombosis | ||
**Therapeutic heparin | **Therapeutic [[heparin]] | ||
===Prophylaxis=== | ===Prophylaxis=== | ||
*Eliminate risk factors (OCPs, smoking, | *Eliminate risk factors (OCPs, smoking, hypertension and HL) | ||
*Low-dose ASA | *Low-dose [[ASA]] | ||
==Disposition== | ==Disposition== | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
Latest revision as of 04:45, 1 October 2019
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
- Nonfunctional
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
- Genetic
Evaluation
Management
- Thrombosis (e.g. extremity phlebitis or dural sinus vein thrombosis)
Pregnancy
Miscarriage is common
- Prophylaxis for most women
- Patients with pregnancy loss
- Patients with history of thrombosis
- Therapeutic heparin
Prophylaxis
- Eliminate risk factors (OCPs, smoking, hypertension and HL)
- Low-dose ASA