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) | |||
*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 | |||
==Management with | ==Clinical Features== | ||
*Recurrent [[arterial thrombosis|arterial]]/[[venous thrombosis|venous thromboembolism]] | |||
*Recurrent [[miscarriage|fetal loss]] | |||
==Differential Diagnosis== | |||
{{Increased bleeding DDX}} | |||
==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== | ==See Also== | ||
*[[Coagulopathy (Main)]] | *[[Coagulopathy (Main)]] | ||
== | ==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