Lupus anticoagulant
From Wikipedia, the free encyclopedia
| Lupus anticoagulant | |
|---|---|
| Classification and external resources | |
| ICD-9 | 289.81 |
| OMIM | 107320 |
| DiseasesDB | 775 |
| MeSH | D016682 |
Lupus anticoagulant (also known as lupus antibody, LA, or lupus inhibitors) is a medical phenomenon where autoantibodies bind to phospholipids and proteins associated with the cell membrane. Since interactions between the cell membrane and clotting factors are necessary for proper functioning of the coagulation cascade, the lupus anticoagulant can interfere with blood clotting as well as in-vitro tests of clotting function. Paradoxically, lupus anticoagulants are also risk factors for thrombosis.
Conceptually, lupus anticoagulants overlap with the antiphospholipid antibody syndrome. Lupus anticoagulants can be understood as the tendency of antiphospholipid antibodies to prolong the clotting times, especially in phospholipid rich clotting testing such as the dilute Russell's viper venom time.
Often, the lupus anticoagulant is diagnosed on asymptomatic patients by a routine blood testing prior to surgery. Patients with a lupus anticoagulant are prone to thrombosis, excess bleeding, and habitual abortion (repeated miscarriages).
[edit] Terminology
Both words in the term "lupus anticoagulant" can be misleading:
- Most patients with a lupus anticoagulant do not actually have lupus erythematosus, and only a small proportion will proceed to develop this disease (which causes joint pains, skin problems and renal failure, amongst other complications). Patients with lupus erythematosus are more likely to develop a lupus anticoagulant than the general population..
[edit] Treatment
Treatment for a lupus anticoagulant is usually undertaken in the context of documented thrombosis, such as extremity phlebitis or dural sinus vein thrombosis. Patients with a well-documented (i.e., present at least twice) lupus anticoagulant and a history of thrombosis should be considered candidates for indefinite treatment with anticoagulants. Patients with no history of thrombosis and a lupus anticoagulant should probably be observed. Current evidence suggests that the risk of recurrent thrombosis in patients with an antiphospholipid antibody is enhanced whether that antibody is measured on serological testing or functional testing. The Sapporo criteria specify that both serological and functional tests must be positive to diagnose the antiphospholipid antibody syndrome.[1].
Miscarriages may be more prevalent in patients with a lupus anticoagulant. These can be prevented with the administration of low molecular weight heparins (LMWHs), and thrombosis is treated with anticoagulants (LMWHs and warfarin).[2]
[edit] References
- ^ Viard JP, Amoura Z, Bach JF (1991). "[Anti-beta 2 glycoprotein I antibodies in systemic lupus erythematosus: a marker of thrombosis associated with a circulating anticoagulant]" (in French). C. R. Acad. Sci. III, Sci. Vie 313 (13): 607–12. PMID 1782567.
- ^ Dolitzky M, Inbal A, Segal Y, Weiss A, Brenner B, Carp H (2006). "A randomized study of thromboprophylaxis in women with unexplained consecutive recurrent miscarriages". Fertil Steril 86 (2): 362–6. doi:. PMID 16769056.
