Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature (original) (raw)
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Haematologica, 1999
Prolonged anticoagulation aiming at International Normalized Ratio (INR) values > 3.0 has been recommended for patients with thrombosis and the antiphospholipid-antibody syndrome. We evaluated the influence of anticoagulant antibodies in two different prothrombin time (PT) assays carried out on plasma from lupus anticoagulant patients on oral anticoagulation. INR values obtained with a combined (final test plasma dilution 1:20) and a recombinant (final test plasma dilution 1:3) thromboplastin were compared in 17 patients with persistent lupus anticoagulants (LA) receiving oral anticoagulant treatment and monitored for 69.8 patient-years. Doses of anticoagulant drugs were always assigned based on the results obtained with the combined thromboplastin, aiming at a target INR of 2.5 or 3.0 for patients with venous or arterial thromboembolic disease. Paired determinations with both reagents were also obtained throughout the study period in 150 patients on stable oral anticoagulation b...
Blood, 2015
Data on the clinical course of lupus anticoagulant (LA) positive individuals with or without thrombotic manifestations or pregnancy complications are limited. To investigate mortality rates and factors that might influence mortality, we conducted a prospective observational study of LA positive individuals. In total, 151 patients (82% female) were followed for median of 8.2 years, of whom 30 patients (20%) developed 32 thromboembolic events (15 arterial and 17 venous events) and 20 patients (13%) died. In univariable analysis new onset of thrombosis (HR=8.76, 95%CI 3.46-22.16) was associated with adverse survival. Thrombosis remained a strong adverse prognostic factor after multivariable adjustment for age and hypertension (HR=5.95, 95%CI 2.43-14.95). Concomitant autoimmune diseases, anticoagulant treatment at baseline or positivity for anticardiolipin- or anti-β2-glycoprotein I antibodies were not associated with mortality. In a relative survival analysis, our cohort of LA positive...
BMC medicine, 2017
Patients with the lupus anticoagulant (LA) are at an increased risk of thrombotic events, which in turn increase the risk of death. Understanding the determinants of thrombotic risk in patients with LA may pave the way towards targeted thromboprophylaxis. In the Vienna Lupus Anticoagulant and Thrombosis Study (LATS), we systematically evaluate risk factors for thrombotic events in patients with LA. We followed 150 patients (mean age: 41.3 years, female gender: n = 122 (81.3%), history of thrombosis or pregnancy complications: n = 111 (74.0%)), who tested repeatedly positive for LA until development of thrombosis, death, or censoring. The primary endpoint was a composite of arterial or venous thrombotic events (TEs). During a median follow-up of 9.5 years (range: 12 days-13.6 years) and 1076 person-years, 32 TEs occurred (arterial: n = 16, venous: n = 16; cumulative 10-year TE incidence: 24.3%). A prolonged lupus-sensitive activated partial thromboplastin time (aPTT-LA) (adjusted sub...
Blood, 2010
more than the quantification of lupus anticoagulants Thrombotic risk assessment in the antiphospholipid syndrome requires http://bloodjournal.hematologylibrary.org/content/115/4/870.full.html Updated information and services can be found at: (583 articles) Thrombosis and Hemostasis (5019 articles) Immunobiology (1725 articles) Free Research Articles (3716 articles) Clinical Trials and Observations Articles on similar topics can be found in the following Blood collections http://bloodjournal.hematologylibrary.org/site/misc/rights.xhtml#repub\_requests Information about reproducing this article in parts or in its entirety may be found online at: http://bloodjournal.hematologylibrary.org/site/misc/rights.xhtml#reprints Information about ordering reprints may be found online at: http://bloodjournal.hematologylibrary.org/site/subscriptions/index.xhtml Information about subscriptions and ASH membership may be found online at: Lupus anticoagulants (LACs) are associated with thromboembolic complications (TECs). LACs can be detected by their anticoagulant properties in thrombin generation assays, by the peak height (PH) and lag time (LT). To assess the thrombotic risk in LAC-positive patients, we have expressed the LAC activity quantitatively by PH/LT calibration curves, constructed for mixtures of monoclonal antibodies against 2-glycoprotein I (2GPI) and prothrombin, spiked in normal plasma. PH/LT was determined in LAC patients, with (n ؍ 38) and without (n ؍ 21) TECs and converted into arbitrary LAC units. LAC titers ranged from 0 to 200 AU/mL, with 5 of 59 patients being negative. In the positive LAC titer population (54 of 59), LAC and anti-2GPI immunoglobulin G (IgG) titers correlated with TECs, with odds ratios of 3.54 (95% CI, 1.0-1.7) and 10.0 (95% CI, 1.98-50.6), respectively. In patients with single or combined low titers, useful predictions on thrombosis could be made only after additional measurements of soluble Pselectin and factor VII. This layered strategy yielded positive and negative predictive values, sensitivity, and specificity values approximately 90% in this subgroup. Hence, LAC and anti-2GPI IgG titers, when combined with selected markers of the hypercoagulable state, allow a relevant thrombotic risk assessment in nearly all patients with LACs. (Blood.
Antiphospholipid antibodies and thrombosis: do test patterns identify the patients' risk?
Thrombosis Research, 2004
We retrospectively analyzed the antiphospholipid profile of 103 lupus anticoagulant-positive patients to investigate whether laboratory patterns emerged for their association with arterial and venous thrombosis in the antiphospholipid syndrome. Anticardiolipin, anti-bbetaN2-glycoprotein I and antiprothrombin antibodies were combined with coagulation tests in different patterns, which included from 2 to 5 laboratory variables. Overall, 22 out of 180 available associations reached significance: 14 with any type of thrombosis and eight with venous thrombosis. In all but two cases, anticardiolipin antibodiesN40 units were present in the laboratory patterns that reached significance. Anti-bbetaN2-glycoprotein I antibodies were present in 11 significant patterns, and antiprothrombin antibodies in seven cases. Increasing the number of variables of the laboratory patterns did not increase the odds ratio (OR) towards thrombosis. In conclusion, this analysis confirmed that the presence of IgG anticardiolipin antibodies at medium to high titres, either alone or in various combinations with other tests, is clinically useful to establish the patients' risk of thrombosis. The role of the other antiphospholipid antibodies is less clear.
Lupus Anticoagulant Syndrome: A Case Report
Journal of Emergency Medicine, 2010
e Abstract-Thromboses of the deep veins (DVT) and potential complications are disorders with which physicians need to be well familiarized so they can be recognized and managed. Hypercoagulable states play a significant role in the development of DVT and these disorders must be suspect when thrombosis occurs, especially in the upper extremities. Antiphospholipid antibody syndrome (APS) is one such hypercoagulable state in which autoantibodies are formed against anionic phospholipid complexes. In vivo, these antibodies cause a hypercoagulable state through a number of proposed mechanisms, whereas in vitro they interfere with the assembly of phospholipid complexes, thereby inhibiting coagulation and prolonging various clotting times. Though appearing to be anticoagulated on ancillary testing, patients with APS are actually in a prothrombotic state requiring treatment with the anticoagulants heparin and warfarin. This case discussion focuses on the recognition and treatment of thrombotic events in the setting of APS.
Blood, 2004
thrombosis in the antiphospholipid syndrome dependent lupus anticoagulant highly correlates with − 2-glycoprotein I β http://bloodjournal.hematologylibrary.org/content/104/12/3598.full.html Updated information and services can be found at: (2497 articles) Hemostasis, Thrombosis, and Vascular Biology (3716 articles) Clinical Trials and Observations Articles on similar topics can be found in the following Blood collections http://bloodjournal.hematologylibrary.org/site/misc/rights.xhtml#repub\_requests