Lupus anticoagulant: Difference between revisions

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
- 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
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

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Misnomer as it is a prothrombotic agent in-vivo (anticoagulant in-vitro), and most pts do not actually have SLE (small proportion develop disease)
+*Misnomer as it is a prothrombotic agent in-vivo (anticoagulant in-vitro in the lab)
-**SLE pts more likely to develop lupus anticoagulant
+*Most patients do not actually have [[SLE]] (small proportion develop disease), but SLE patients more likely to develop lupus anticoagulant
-*Antiphospholipid syndrome (APS), where there are directed antibodies against membrane anionic phospholipids, or their associated plasma proteins
+*Included in [[antiphospholipid syndrome]] (APS), where there are directed antibodies against membrane anionic phospholipids, or their associated plasma proteins
-*Leads to recurrent venous/arterial thrombosis and/or fetal loss
+**Increases aPTT
+==Clinical Features==
+*Recurrent [[arterial thrombosis|arterial]]/[[venous thrombosis|venous thromboembolism]]
+*Recurrent [[miscarriage|fetal loss]]
+==Differential Diagnosis==
+{{Increased bleeding DDX}}
+==Evaluation==
 ==Management==
-#PPx
+*Thrombosis (e.g. extremity [[phlebitis]] or dural [[sinus vein thrombosis]])
-##Eliminate risk factors (OCPs, smoking, HTN and HL)
+**[[Heparin]] IV/SQ followed by [[warfarin]] +/- [[ASA]]
-##Low-dose ASA
+**Goal INR
-#Thrombosis (ie Extremity phlebitis or dural sinus vein thrombosis)
+***Venous 2.0-3.0
-##Heparin IV/SQ followed by warfarin +/- ASA
+***Arterial 3.0
-##Goal INR
+***Recurrent 3.0-4.0
-###Venous 2.0-3.0
-###Arterial 3.0
+===Pregnancy===
-###Recurrent 3.0-4.0
+''[[Miscarriage]] is common''
-#OB - Miscarriage is common
+*Prophylaxis for most women
-##PPx for most women
+*Patients with pregnancy loss
-##Pts with pregnancy loss
+**Prophylactic [[heparin]] and low-dose [[ASA]]
-###Prophylactic heparin and low-dose ASA
+*Patients with history of thrombosis
-##Pts with h/o thrombosis
+**Therapeutic [[heparin]]
-###Therapeutic heparin
+===Prophylaxis===
+*Eliminate risk factors (OCPs, smoking, hypertension and HL)
+*Low-dose [[ASA]]
+==Disposition==
 ==See Also==
 *[[Coagulopathy (Main)]]
-==Source==
+==References==
-*Tintinalli
+<references/>
-*UpToDate
 [[Category:Heme/Onc]]