Evaluating hypercoagulability in new‐onset systemic lupus erythematosus patients using thromboelastography

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease that involves T cell, B cell, and dendritic cell dysfunction, as well as antinuclear autoantibody production. 1 Several clinical and scientific studies of SLE indicate an increased risk of thrombosis in these cases. [2][3][4][5] Moreover, patients with SLE may exhibit accelerated atherosclerosis, and higher cardiovascular morbidity and mortality. 6The traditional parameters for screening coagulopathy include prothrombin time (PT) and activated partial thromboplastin time (aPTT). However, in Owaidah's study, among patients with positive lupus anticoagulant (LAC) status, 61% exhibited abnormal aPTT results that could not be corrected by mixing with normal plasma; moreover, the PT test yielded normal results in 90% cases. 7 However, there is a limitation of the aPTT and PT test in these cases, as the results may reflect a certain product in the coagulation process, rather than the actual marker they are intended to reflect. Moreover, SLE Abstract Background: Thromboelastography (TEG) can reflect the coagulation status in vivo, from clot formation to clot lysis. In the present study, we aimed to evaluate the function of TEG in detecting coagulation in patients with SLE and sought to explore the correlation between clinical and laboratory data. Methods:A total of 41 patients with new-onset SLE who had not undergone treatment and 56 healthy controls were included. TEG and other laboratory tests were performed, and clinical data were collected.Results: A significant difference in the TEG reaction time and TEG achievement of clot firmness was observed between the groups. Moreover, these parameters were correlated with the lupus anticoagulant levels, platelet count, 24-hour urinary total protein quantity, and systemic lupus erythematosus disease activity index. Conclusion:Our study demonstrated the prospective value of TEG in evaluating hypercoagulability in patients with SLE.

The Atypical Fibrin Fibre Network in Rheumatoid Arthritis and its Relation to Autoimmunity, Inflammation and Thrombosis

“…Limited viscoelastic assessment of coagulation in RA has been performed to date (60,63,64), with TEG ® not commonly used in rheumatology practice (65)(66)(67). RA patients showed significantly altered rates of clot formation compared to healthy controls.…”

Viscoelastic testing in benign hematologic disorders: Clinical perspectives and future implications of point‐of‐care testing to assess hemostatic competence

“…These antibodies or the disease itself pose a risk for venous thomboembolic events and pregnancy-related complications. 149,152,[177][178][179][180][181][182][183][184][185] Other autoimmune disorders (excluding the vasculitides) that have the potential to cause hypercoagulability include rheumatoid disease, psoriatic disease, and Sjogren syndrome. 181,[185][186][187][188] VETs have shown that C3 and tumor necrosis factor (TNF)-α may have a direct effect in propagating hypercoagulation, specifically on fibrin formation.…”

“…Abbreviations: A, α-angle; aPTT, activated partial thromboplastin time; CFT, clot formation time; FFP, fresh-frozen plasma; K, kinetics; LMWH, low-molecular-weight heparin; NC, normal control; SCT, sickle cell trait; Stx2a, Shiga toxin 2 subunit a. 190,192 CFT: # 192 A: " 190,192 MCF: " 190,192 Variable VET variables Hypercoagulability has been demonstrated using VETs and these changes were shown to correlate with disease activity antibody levels 177,178,192 CT: 193,194 Treatments guided by VETs:…”

“…It is well described that systemic lupus erythematosus patients can develop specific antibodies such as lupus anticoagulant, antiphospholipid syndrome, antiprothrombin, and anticardiolipin; these antibodies often result in coagulopathies. These antibodies or the disease itself pose a risk for venous thomboembolic events and pregnancy‐related complications 149,152,177–185 . Other autoimmune disorders (excluding the vasculitides) that have the potential to cause hypercoagulability include rheumatoid disease, psoriatic disease, and Sjogren syndrome 181,185–188 .…”

“…Table 6 presents TEG/ROTEM variables associated with various systemic autoimmune diseases and the potential implications of those variables. Studies have revealed that patients with active systemic lupus erythematosus and related disorders show a distinct hematologic pattern characteristic of a hypercoagulable state; however, there are varying degrees of changes in VET variables in patients with active disease, which suggests diversity in associated pathophysiologic mechanisms 177,178,192,193,196,200,218 . Rheumatoid arthritis has been associated with a hypercoagulable state, which suggests an increased risk of venous thomboembolic events and is a strong predicting factor for a prothrombotic state 187,205 .…”