Lupus anticoagulant

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

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
  • Hemophilia
  • Factor VIII inhibitor
  • Lupus anticoagulant

Management

1. PPx
   1. Eliminate risk factors (OCPs, smoking, HTN and HL)
   2. Low-dose ASA
2. Thrombosis (ie Extremity phlebitis or dural sinus vein thrombosis)
   1. Heparin IV/SQ followed by warfarin +/- ASA
   2. Goal INR
      1. Venous 2.0-3.0
      2. Arterial 3.0
      3. Recurrent 3.0-4.0
3. OB - Miscarriage is common
   1. PPx for most women
   2. Pts with pregnancy loss
      1. Prophylactic heparin and low-dose ASA
   3. Pts with h/o thrombosis
      1. Therapeutic heparin

See Also

• Coagulopathy (Main)