Lupus anticoagulant: Difference between revisions
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*Eliminate risk factors (OCPs, smoking, | *Eliminate risk factors (OCPs, smoking, hypertension and HL) | ||
*Low-dose ASA | *Low-dose ASA | ||
Revision as of 11:32, 30 July 2016
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
- 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
Evaluation
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, hypertension and HL)
- Low-dose ASA