Lupus Anticoagulant, Thrombosis, and Fetal Loss

Feinstein, Donald I.

doi:10.1056/nejm198511213132109

Cited by 141 publications

(44 citation statements)

References 12 publications

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“…20,23 The etiology of subchorionic hematoma is worth discussing, since this is also unclear. Subchorionic hematoma has been shown not only in patients with threatened abortion, but also in patients with bleeding disorders, 24 patients with the presence of autoantibodies, 25,26,27 as well as patients receiving anticoagulants. 28 Indeed, vasculopathies associated with certain disease states such as hypertension have been suggested as being able to make placental vessels more fragile, and therefore at greater risk of hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Subchorionic Hematoma in Threatened Abortion: Sonographic Evaluation and Significance

Al-Nuaim

Adelusi

1996

Ann Saudi Med

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In a study of 92 women with subchorionic hematoma evaluated with sonographic scan in King Khalid University Hospital, it was found that the mean ages and live births of patients who carried their pregnancies to viability were higher when compared with the patients who aborted. There was a statistically significant association between the gestational age at diagnosis of subchorionic hematoma and the size of the hematoma. There was, however, no statistically significant association found between the gestational age at diagnosis, size and site of the hematoma and the outcome of pregnancy. It was concluded that subchorionic hematoma which appear either in the second trimester, or are larger, or located in the lower uterine segment, may be associated with higher rates of abortion or preterm deliveries. Nevertheless, there is no statistically significant impact of these on the outcome of pregnancy. Ann Saudi Med 1996;16(6):650-653. L Al-Nuaim, N Chowdhury, B Adelusi, Subchorionic Hematoma in Threatened Abortion: Sonographic Evaluation and Significance. 1996; 16(6): 650-653 Vaginal bleeding, one of the features of early pregnancy miscarriage, occurs in up to 25% of all pregnancies, 1-3 although the reported incidence of at least 16% of clinically recognized pregnancies, quoted by Hertig and Livingstone 4 some 50 years ago, is probably still correct today. The natural worry of women with threatened abortion is the loss of their pregnancies, and in about 30% to 50% of cases, that fear may be justifiable. 5,6 The symptoms and signs of threatened abortion are so variable that the outcome of the pregnancy cannot be reliably predicted by the clinical features at presentation. 7 Thus, various biochemical and biophysical tests have been applied extensively in attempts to improve the accuracy of predicting the outcome of these pregnancies. [8][9][10] At present there is no single test that can accurately determine outcome of pregnancy after threatened abortions. However, ultrasonic examination has revolutionized clinical practice by providing definite evidence of the viability of a pregnancy as early as six weeks. 1,10,11 One of the sonographic features used in the evaluation of fetal viability in early pregnancy is the presence of subchorionic hematoma, which appears to have gained some prominence lately. 1-3,10-13 Indeed, it has been suggested that this can be used to predict the outcome of pregnancy when correlated with fetal activities such as motion and cardiac function. 1 We present here a prospective study of the ultrasonographic evaluation of patients with vaginal bleeding in early and second trimester of pregnancy, to determine the gestational age at diagnosis of, and the size and site of subchorionic hematoma, and to correlate these with pregnancy outcome. Material and MethodsDuring the period September 1992 to August 1994, 1082 pregnant patients who had completed between six and 23 weeks of gestation, as based on sonographic estimation of age using the crown-rump length (CRL) or biparietal diameter (BPD), were ...

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Section: Discussionmentioning

confidence: 99%

Subchorionic Hematoma in Threatened Abortion: Sonographic Evaluation and Significance

Al-Nuaim

Adelusi

1996

Ann Saudi Med

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“…No previous study has examined the frequency of laboratory findings that are generally associated with lupus (antinuclear antibodies [ANA], anti-Ro, lupus anticoagulant [LAC], and anticardiolipin [ACL] antibody among women with idiopathic habitual abortion ( 3 or more consecutive spontaneous abortions) compared with the frequency among normal controls. In the absence of controlled trials, it has been proposed that ANA, anti-Ro, LAC, and ACL, antibodies play a causal role in idiopathic habitual abortion and that treatment of the problems indicated by these laboratory findings may be necessary (7)(8)(9)(10).…”

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confidence: 99%

Antinuclear antibody, lupus anticoagulant, and anticardiolipin antibody in women with idiopathic habitual abortion. A controlled, prospective study of forty‐four women

Petri

Golbus

Anderson

et al. 1987

Arthritis & Rheumatism

164

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In a controlled, prospective study of 44 consecutive women with idiopathic habitual abortion, only 5% had symptoms of rheumatic disease. Patients did not differ from control subjects in the frequency of positive results on tests for antinuclear antibody or anti-doublestranded DNA. Levels of C3 and C4 were higher in the habitual aborters. No patients had anti-Ro. The antiphospholipid antibody results were analyzed using 2 methods: the frequency of antiphospholipid antibodies was 9% by lupus anticoagulant using the Russell viper venom time (95% confidehce interval 22-2.5). and 11% by anticardiolipin antibody assay (95% confidence interval 25-3.7), which was not significantly different from that in control subjects. However, the mean levels in the aborters (although within the normal range) were Submitted for publication August 18, 1986; accepted in revised form January 7, 1987. significantly higher than those in control subjects for anti-double-stranded DNA (P = 0.004), lupus anticoagulant (by Russell viper venom time; P = 0.09), and anticardiolipin antibody (P = 0.0007), when examined by multiple linear regression analysis corrected for age and concurrent pregnancy. Of the 3 patients with antiphospholipid antibodies and subsequent successful pregnancies, only 1 was treated with prednisone and aspirin. We conclude that, in the majority of women, subclinical lupus, anti-Ro, the lupus anticoagulant, and anticardiolipin antibodies are not associated with idiopathic habitual abortion.Women with systemic lupus erythematosus (SLE) have an increased frequency of spontaneous abortions (1-4), but most women who habitually abort do not meet criteria for the diagnosis of SLE (5,6). No previous study has examined the frequency of laboratory findings that are generally associated with lupus (antinuclear antibodies [ANA], anti-Ro, lupus anticoagulant [LAC], and anticardiolipin [ACL] antibody among women with idiopathic habitual abortion ( 3 or more consecutive spontaneous abortions) compared with the frequency among normal controls. In the absence of controlled trials, it has been proposed that ANA, anti-Ro, LAC, and ACL, antibodies play a causal role in idiopathic habitual abortion and that treatment of the problems indicated by these laboratory findings may be necessary (7-10).We now report the frequency of ANA, antidouble-stranded DNA (dsDNA), anti-Sm, anti-RNP, anticentromere antibody, anti-Ro, anti-La, cornple-

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“…However, in the LA-positive patients without thrombosis, plasma F VIIa was also markedly increased, but plasma TAT level was not. Reduced plasma protein C and increased plasma activated protein C-protein C inhibitor complex have been reported previously in patients with LA [21] and the presence of LA is considered a risk factor for thrombosis [12,13]. As these LA-positive patients are considered to exhibit a hypercoagulable state, it is conceivable that plasma F VIIa could be more sensitive than TAT for the diagnosis of such a state.…”

Section: Discussionmentioning

confidence: 91%

“…However, they have now been identified in a number of other pathological conditions, as well as in apparently normal subjects [11]. In recent years, it has become clear that the presence of LA is a risk factor for thrombosis [12,13], for recurrent spontaneous abortion [14], for thrombocytopenia, and for a variety of neurological disorders. LA are immunoglobulins that interfere with a variety of coagulation assays, prolonging phospholipiddependent coagulation [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Plasma-activated factor VII level in patients positive for lupus anticoagulant

et al. 1997

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We examined plasma levels of activated factor VII (F VIIa) in 50 patients positive for lupus anticoagulant (LA), in 83 patients negative for LA, and in 10 healthy volunteers as controls. Plasma F VIIa was present in healthy volunteers; its level was significantly increased, compared to the level in the controls, in patients with thrombosis, collagen diseases, and disseminated intravascular coagulation (DIC), suggesting that it reflected a thrombotic state. Plasma F VIIa was correlated with thrombin-antithrombin complex (TAT) in patients negative for LA but showed no such correlation in those positive for LA. Plasma F VIIa was negatively correlated with activated partial thromboplastin time (APTT) in patients positive for LA, but not in those negative for LA, suggesting that LA could inhibit the F VIIa assay system. Plasma F VIIa level was significantly increased in patients with thrombotic diseases; however, in patients positive for LA, it is possible that increased plasma F VIIa level may not be correlated with thrombogenicity. Am.

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Lupus Anticoagulant, Thrombosis, and Fetal Loss

Cited by 141 publications

References 12 publications

Subchorionic Hematoma in Threatened Abortion: Sonographic Evaluation and Significance

Subchorionic Hematoma in Threatened Abortion: Sonographic Evaluation and Significance

Antinuclear antibody, lupus anticoagulant, and anticardiolipin antibody in women with idiopathic habitual abortion. A controlled, prospective study of forty‐four women

Plasma-activated factor VII level in patients positive for lupus anticoagulant

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