Lupus anticoagulant

Revision as of 22:48, 7 January 2014 by ManpreetS2006 (talk | contribs) (minor edit)

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)
    • 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
  • Leads to recurrent venous/arterial thrombosis and/or fetal loss

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

Source

  • Tintinalli
  • UpToDate