DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20221974
Published: 2022-07-27

Lupus anticoagulant in systemic lupus erythematosus and its association with complications

Silpa S. Raj, Sankar S., Anju C. K., Irshad Ali K. M.

Abstract


Background: The anti-phospholipid antibody which can occur secondary to SLE have a broad spectrum of both thrombotic and non-thrombotic manifestations. Among the three antiphospholipid antibodies, lupus anticoagulant has the strongest association with antiphospholipid syndrome (APS) and increased chance of recurrence of thrombotic events. Hence early screening of lupus anticoagulant is needed.

Methods: 72 clinically diagnosed SLE patients were included. The PT, aPTT were done in all patients. The clotting time is assessed by semi-automated coagulation analyser by using dilute russell viper venom time (dRVV) screen and confirm kits. Lupus anticoagulant was considered to be positive if the screen to confirm ratio is ≥1.2. The patients were followed up for a period of 1 year at regular 3 months interval. The various complications like hemolytic anemia, thrombocytopenia, deep vein thrombosis, cerebrovascular accident/transient ischemic attack (CVA/TIA), myocardial infarction, abortions, pulmonary artery hypertension and lupus nephritis were recorded.

Results: Lupus anticoagulant was positive in 38.8% among the study group. The most common thrombotic event observed was DVT (16.7%) followed by MI (11.1%) and CVA/TIA (8.3%). There is significant association between lupus anticoagulant positivity with hemolytic anemia, DVT and pulmonary artery hypertension.

Conclusions: The lupus anticoagulant has the strongest association with APS in SLE patients and dRVVT is the test of choice in diagnosing APLA. Early recognition of APLA can reduce the risk of thrombotic complications and can prevent further episodes by giving adequate thromboprophylaxis to lupus anticoagulant positive patients.


Keywords


Lupus anticoagulant, dRVVT, Anti-phospholipid syndrome, Significant association

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References


Putterman C, Caricchio R, Davidson A, Perlman H. Systemic lupus erythematosus. Clin Dev Immunol. 2012;2012:437282.

Vaillant A, Akpaka EP, Poonking P. Systemic Lupus Erythematosus: some Epidemiological and Clinical Aspects. American J Public Health Res. 2015;3(2):46-50.

Estel GJ, Quintana R, Alarcón GS, Sacnún M, Gil MF, Estel BA, et al. A 12-year retrospective review of bullous systemic lupus erythematosus in cutaneous and systemic lupus erythematosus patients. Lupus. 2018;27(10):1753-4.

Lewis MJ, Jawad AS. The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematosus. Rheumatology (Oxford). 2017;56(1):67-77.

Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med. 2002;346(10):752-63.

Rauch J, Dieudé M, Subang R, Levine JS. The dual role of innate immunity in the antiphospholipid syndrome. Lupus. 2010;19(4):347-53.

Namjou B. Antiphospholipid syndrome: genetic review. Curr Rheumatol Rep. 2003;5(5):391-4.

Furmańczyk A, Komuda-Leszek E, Gadomska W, Windyga J, Durlik M. Catastrophic antiphospholipid syndrome. Pol Arch Med Wewn. 2009;119(6):427-30.

Garcia D, Erkan D. Diagnosis and Management of the Antiphospholipid Syndrome. N Engl J Med. 2018;378(21):2010-21.

Cervera R, Font J, Khamashta MA, Hughes GR. Antiphospholipid antibodies: which and when? Postgrad Med J. 1990;66(781):889-91.

Boey ML, Colaco CB, Gharavi AE, Elkon KB, Loizou S, Hughes GR. Thrombosis in systemic lupus erythematosus: striking association with the presence of circulating lupus anticoagulant. Br Med J (Clin Res Ed). 1983;287(6398):1021-3.

Irastorza G, Egurbide MV, Ugalde J, Aguirre C. High impact of antiphospholipid syndrome on irreversible organ damage and survival of patients with systemic lupus erythematosus. Arch Intern Med. 2004;164(1):77-82.

Nalli C, Andreoli L, Casu C, Tincani A. Management of recurrent thrombosis in antiphospholipid syndrome. Curr Rheumatol Rep. 2014;16(3):405.

Otomo K, Atsumi T, Amengual O, Fujieda Y, Kato M, Oku K, et al. Efficacy of the antiphospholipid score for the diagnosis of antiphospholipid syndrome and its predictive value for thrombotic events. Arthritis Rheum. 2012;64(2):504-12.

Ross T, Ruffatti A, Visentin MS, Tonello M, Calligaro A, Favaro M, et al. Treatment of 139 pregnancies in antiphospholipid-positive women not fulfilling criteria for antiphospholipid syndrome: a retrospective study. J Rheumatol. 2013;40(4):425-9

Sassi RH, Hendler JV, Piccoli GF, Gasparin AA, Silva RM, Brenol JC, et al. Age of onset influences on clinical and laboratory profile of patients with systemic lupus erythematosus. Clin Rheumatol. 2017;36(1):89-95.

Kishor N, Boloor R, Sukumar T. A cross-sectional study of clinico-immunological profile of systemic lupus erythematosus patients in a tertiary care centre in Mangalore. Indian J Allergy Asthma Immunol. 2016;30(2):91.

Sufian A, Kashem M, Biswas S. Pattern of Hematological Manifestations in Patients with Systemic Lupus Erythematosus Attending in a Tertiary Care Hospita. J Med. 2017;18(2):86-91.

Sasidharan PK, Bindya M, Sajeeth KKG. Hematological Manifestations of SLE at Initial Presentation: Is It Underestimated?. ISRN Hematol. 2012;2012:961872.

Woo KS, Kim KE, Kim JM, Han JY, Chung WT, Kim KH. Prevalence and clinical associations of lupus anticoagulant, anticardiolipin antibodies, and anti-beta2-glycoprotein I antibodies in patients with systemic lupus erythematosus. Korean J Lab Med. 2010;30(1):38-44.

Garg S, Kurien A. Lupus anticoagulant and anticardiolipin antibodies in SLE with secondary Antiphospholipid Antibody Syndrome. Turk J Haematol. 2007;24(2):69-74.

Tarr T, Lakos G, Bhattoa HP, Soltesz P, Shoenfeld Y, Szegedi G, et al. Clinical thrombotic manifestations in SLE patients with and without antiphospholipid antibodies: a 5-year follow-up. Clin Rev Allergy Immunol. 2007;32(2):131-7.

Cervera R, Serrano R, Estel GJ, Hualde L, Shoenfeld Y, Ramón E, et al. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis. 2015;74(6):1011-8.