Insights into the Procoagulant Profile of Patients with Systemic Lupus Erythematosus without Antiphospholipid Antibodies

Abstract

We aimed to identify the key players in the prothrombotic profile of patients with systemic lupus erythematosus (SLE) not mediated by antiphospholipid antibodies, as well as the potential utility of global coagulation tests to characterize hemostasis in these patients. Patients with SLE without antiphospholipid antibodies and without signs of thrombosis were included. The kinetics of clot formation were determined by ROTEM®. Platelet activation markers were determined by flow cytometry. Thrombin generation associated with Neutrophil Extracellular Traps (NETs) and microparticles (MPs) was measured by calibrated automated thrombogram (CAT). The plasma levels of PAI-1 were also determined. ROTEM® showed a procoagulant profile in SLE patients. SLE patients had activated platelets and more leukocyte/platelet aggregates at basal conditions. The plasma PAI-1 and platelet aggregates correlated with several ROTEM® parameters. The thrombin generation associated withthe tissue factor (TF) content of MPs and with NETs was increased. Our results suggest the utility of global tests for studying hemostasis in SLE patients because they detect their procoagulant profile, despite having had neither antiphospholipid antibodies nor any previous thrombotic event. A global appraisal of hemostasis should, if possible, be incorporated into clinical practice to detect the risk of a thrombotic event in patients with SLE and to consequently act to prevent its occurrence.

Incidence of COVID-19 Hospitalisation in Patients with Systemic Lupus Erythematosus: A Nationwide Cohort Study from Denmark

“…Another limitation is that our dataset was rather small in terms of outcomes (hospitalisations) among SLE patients, especially when it came to specific treatment types for SLE. Furthermore, no information on kidney and lung function was available, and nor could we collect specific information regarding the prothrombotic state that patients with SLE experience due to antiphospholipid syndromes and other potential SLE-intrinsic prothrombotic risk factors [28]. It cannot be ruled out that the increased incidence of hospitalisation in SLE patients could to some extent be explained by either of these factors.…”

Applicability of the Thrombin Generation Test to Evaluate the Hemostatic Status of Hemophilia A Patients in Daily Clinical Practice

“…As a result, FVIII:C or FVIII:Chr levels do not seem to be sufficiently informative to identify those HA patients at a higher bleeding risk, especially for those patients with mild or moderate HA. As employed in other clinical situations [ 39 , 40 , 41 , 42 , 43 ], the TGT may represent a valuable tool to evaluate the hemostatic status of HA patients [ 16 , 17 , 18 , 19 , 20 ], in a more physiologically relevant manner, provided it monitors the capacity of the patient´s plasma to generate thrombin. However, previous studies have utilized TGT platforms despite the acknowledged limitations around the lack of standardization and automation, narrowing the application of findings using those platforms to highly specialized, low N settings.…”

Risk Assessment and Antithrombotic Strategies in Antiphospholipid Antibody Carriers

“…SLE is a systemic autoimmune disease, characterized by the presence of a wide variety of autoantibodies and multiple organ system involvement [ 40 ]. SLE is characterized by a plethora of clinical manifestations, leading to fatal complications and chronic disability requiring tailored rehabilitation strategies [ 41 , 42 , 43 , 44 , 45 ].…”

“…SLE is characterized by a plethora of clinical manifestations, leading to fatal complications and chronic disability requiring tailored rehabilitation strategies [ 41 , 42 , 43 , 44 , 45 ]. Thrombosis substantially contributes to morbidity and mortality in this clinical setting, being related to a complex interaction between traditional thrombotic risk factors, systemic inflammation, and autoimmunity [ 40 ].…”