The lupus anticoagulant

Abstract

The clinical and laboratory experience with the lupus anticoagulant was reviewed in 37 patients. The anticoagulant is thought to act by blocking the activation of prothrombin by the prothrombin activator complex of factors Xa, V, and phospholipid. Although the anticoagulant has been principally associated with diseases of immune origin, 14 of the present patients had disorders not thought to be immune in nature. Eighteen patients underwent twenty-one operative procedures with only a single episode of excessive bleeding. In the authors' experience, the lupus anticoagulant is a rare cause of bleeding.Circulating anticoagulants directed against specific coagulation factors (XII, X I , I X , a n d VIII) have been sporadically reported in patients with systemic lupus erythematosus (SLE) (1-5). However the most common abnormality o f t h e coagulation system in SLE is the so-called lupus anticoagulant ( L A ) , which appears t o block the activation o f prothrombin by the prothrombin activator complex o f factors Xa, V, a n d phospholipid (6,7). T h e L A is characterized by a prolonged activated partial thromboplastin time ( P T T ) a n d by a mild to moderately prolonged prothrombin time (PT). T h e prolongation of t h e PT is greatly exaggerated when a dilute tissue thromboplastin reagent is utilized, a n d this feature forms the basis of a simple a n d specific test for t h e LA-the dilute tissue thromboplastin assay (7).During t h e past 4 years the authors have tested for t h e From

Lupus-Like in vitro Anticoagulant Activity in End-Stage Renal Disease

“…To our knowledge, this association has not been reported before in prospective studies although sporadic cases associating LLA with uremia or renal impairment has been previously described [14,[29][30][31]. LLA was first described in SLE, although only a small proportion of patients with this anticoagulant is now found to have SLE.…”

Fetal Demise Associated with Lupus Anticoagulant: Clinical Features and Results of Treatment

“…Lupus anticoagulant is thought to occur rarely in nor mal subjects [9,10,17], The original report of Nilsson et al [12] associating intrauterine death with lupus antico agulant has been followed by reports of unsuccessful pregnancies in patients possessing this antibody [17][18][19][20][21].…”

Lupus Anticoagulant and Lacunar Infarctions

“…The initial report of lupus anticoagulant involved hemorrhage [2], but bleeding complications have gener ally involved concomitant platelet dysfunction, throm bocytopenia, or hypoprothrombinemia [4], Retro spective [5] and prospective [6] studies have indicated an undue incidence of thromboembolism in patients with lupus anticoagulant. Recurrent TIA involving var ious arterial territories in young adults who had no angiographic evidence of occlusive cerebrovascular dis ease were reported by Landi et al [7], while multiple strokes accompanied lupus anticoagulant in a young woman with Degos' disease described by Englert et al [8].…”

“…It was first described in patients with systemic lupus ery thematosus (SLE) [2], but has subsequently been associ ated with malignancy and inflammatory disorder, and occurred without any underlying disease [3]. Despite this prolongation of bleeding indices, hemorrhagic complica tions are infrequent [4], A tendency to thromboembo lism has instead been encountered [5,6], Cerebral thrombotic events have been increasingly recognized [7][8][9]. Transient ischemic attacks (TIA) [7] and large-vessel thrombotic infarctions [8-10] have been described, but lacunar infarctions have not heretofore been reported.…”