Lupus anticoagulant

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
  • Vitamin K deficiency
  • Disseminated Intravascular Coagulation (DIC)
  • Liver disease induced coagulopathy
  • Uremic bleeding syndrome
• Genetic
  • Hemophilia
  • Factor VIII inhibitor
  • Lupus anticoagulant

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

See Also

• Coagulopathy (Main)