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[Circulating anticoagulants with antiprothrombinase activity in systemic lupus erythematosus (author's transl)]
Insights
Anticoagulants targeting prothrombin were found in 29% of severe systemic lupus erythematosus (SLE) patients. Their presence, especially without bleeding risks, may not contraindicate kidney biopsy.
Area of Science:
- Rheumatology and Immunology
- Hematology
- Nephrology
Context:
- Severe systemic lupus erythematosus (SLE) often involves renal and extrarenal manifestations.
- Circulating anticoagulants can complicate patient management and diagnostic procedures.
Purpose:
- To investigate the prevalence and clinical significance of circulating anticoagulants with antiprothrombinase activity in severe SLE patients.
- To assess the association of these anticoagulants with disease severity, thrombotic events, and laboratory findings.
- To evaluate the safety of percutaneous renal biopsy in patients with these anticoagulants.
Summary:
- Anticoagulants with antiprothrombinase activity were detected in 29% of severe SLE patients, more common in those with extrarenal disease.
- These anticoagulants were associated with thrombopenia, false-positive Wassermann tests, and a higher incidence in patients with arterial/venous thrombosis.
- Anticoagulant levels correlated with disease activity, and no hemorrhages occurred during renal biopsies in patients without other coagulopathies.
Impact:
- Identifies a specific anticoagulant profile in a significant subset of severe SLE patients.
- Suggests that antiprothrombinase anticoagulants may not pose a prohibitive bleeding risk for kidney biopsies in SLE patients lacking other coagulation disorders.
- Informs clinical decision-making regarding invasive procedures in SLE patients with circulating anticoagulants.
Abstract:
Circulating anticoagulants with antiprothrombinase activity were detected in 14 out of 49 patients (i.e. 29%) presenting with severe forms of systemic lupus erythematosus (SLE) predominantly renal (29) or extrarenal (20). Nine of these 14 patients had thrombopenia and 8 had a falsely positive Wassermann test. The anticoagulants were more frequently encountered in patients with severe extrarenal manifestations (9/20 cases) than in patients with severe proliferative renal lesions (5/29 cases). They were found in 5 out of 10 patients with arterial and/or venous thrombosis. Anticoagulant levels paralleled the course of the disease during treatment. No haemorrhage was observed in 14 percutaneous renal biopsies performed on 11 patients free from outer coagulopathies. This suggests that the presence of antiprothrombinase anticoagulants in the blood of patients without thrombopenia or other coagulation disorders is compatible with surgery or biopsy of the kidney.