Lupus anticoagulant: Difference between revisions
| Line 14: | Line 14: | ||
==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 | ||
| Line 25: | Line 25: | ||
*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 | ||
Revision as of 13:04, 10 June 2015
Background
- Misnomer as it is a prothrombotic agent in-vivo (anticoagulant in-vitro in the lab)
- Most pts do not actually have SLE (small proportion develop disease), but SLE pts 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
- Leads to recurrent venous/arterial thrombosis and/or fetal loss
Clinical Features
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
Diagnosis
Management
- Thrombosis (e.g. extremity phlebitis or dural sinus vein thrombosis)
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, HTN and HL)
- Low-dose ASA