The Lupus Anticoagulant Paradox

Molhoek, Jessica E.; Groot, Philip G. de; Urbanus, Rolf T.

doi:10.1055/s-0037-1606190

Cited by 38 publications

(25 citation statements)

References 69 publications

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“…21 One patient was positive for the lupus anticoagulant, which has been shown to increase the prothrombin time in vitro but paradoxically cause more thrombotic events in vivo. 33 There has been some controversy over the use of anti-Xa measurements on whether it should guide the proper dosing of LMWHs. An adult study has shown that attaining therapeutic anti-factor Xa did not predict either thrombosis or hemorrhage; however, it may still be preferred over prothrombin time or partial thromboplastin time for monitoring therapy.…”

Section: Enoxaparinmentioning

confidence: 99%

Low-Molecular-Weight Heparin and Fondaparinux Use in Pediatric Patients With Obesity

2020

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Objective: The objective of this study is to comprehensively review the efficacy and safety data of low-molecular-weight heparins (LMWHs) and fondaparinux in pediatric patients with obesity. Data Sources: A comprehensive literature search of PubMed, SCOPUS, CINAHL, Academic Search Complete, PsycInfo, Cochrane Library, and Web of Science databases was conducted (1900 to July 2020). Search terms utilized included LMWH, low-molecular-weight heparin, enoxaparin, dalteparin, tinzaparin, fondaparinux, pediatric, child, children, obese, obesity, overweight. No limits or timeline restrictions were imposed. Study Selection and Data Extraction: Studies that reported pediatric patients with described overweight or obesity and utilized LMWHs or fondaparinux were considered. Data Synthesis: Of 207 studies screened, 12 were included. Average dose reductions of 12.9% to 37.3% from the starting dose were observed with treatment indications of enoxaparin and increased up to 27.3% for prophylactic indications. Trends could not be concluded in the dalteparin and fondaparinux studies. Four thrombotic and 15 bleeding events were reported in the studies. Relevance to Patient Care and Clinical Practice: Pediatric patients with obesity may initially be underdosed or overdosed with enoxaparin compared with children with healthy body weight, depending on the indication. Conclusion: Pediatric patients with obesity may benefit from proactively adjusting enoxaparin dosing on initiation of therapy. Further studies are needed for dalteparin and fondaparinux in these populations. Clinical controversy exists with the relevance of monitoring these high-risk medications for therapeutic and prophylactic indications. Thrombotic and hemorrhagic events were similar to reported adult outcomes.

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Section: Enoxaparinmentioning

confidence: 99%

Low-Molecular-Weight Heparin and Fondaparinux Use in Pediatric Patients With Obesity

2020

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“…Even after decades of appearance, the identity of the responsible antigens still remains unsolved. 40 With the consideration of the citrated plasma availability, we were able to perform the LA testing on 70 case patients, of which 30 were from the sporadic miscarriage group and 40 were from the RPL group.…”

Section: Ta B L E 3 Statistical Comparison Of Autoantibodies By Chi-smentioning

confidence: 99%

Detection of non‐criteria autoantibodies in women without apparent causes for pregnancy loss

Zhu

Wang

Dong

et al. 2019

Clinical Laboratory Analysis

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Background Some of the non‐criteria autoantibodies, especially non‐conventional antiphospholipid (aPL) antibodies, were present with high prevalence in sporadic miscarriages and recurrent pregnant loss. However, whether these autoantibodies are associated with miscarriage patients without apparent causes remain unclear. Methods The subjects were recruited from the female patients visiting the Infertility Center at the Beijing Obstetrics and Gynecology Hospital from January 2017 to March 2018. The women who experienced one sporadic miscarriage (n = 89) or recurrent pregnancy loss (n = 125) were enrolled. The control participants (n = 59) were those women with normal pregnancy history and with no miscarriage or thrombosis experience. The collected serum specimens from above patients and controls were subjected to the 13 non‐criteria autoantibody examinations, targeting non‐conventional phospholipids, thyroid, sperm, endometrial, and anti‐nuclear antigens. Results When compared with the controls, the following non‐criteria antibodies stood out in present study with significantly increased frequency and were listed in the order of decreasing positive rates: aPE IgM (40.0%), ANA (15.2%), aEM IgG (13.6%), aPE IgG (12.8%), and aPT IgM (10.4%). Except for ANA, the presence of aPE IgM, aEM IgG, aPE IgG, and aPT IgM was not associated with positivity of LA tests. In receiver operating characteristic analyses, the combined aPE IgG and aEM IgG biomarker panel had the best discriminating power between miscarriage patients and healthy controls. Conclusion Our findings suggested that the non‐criteria could be included as part of the pregnancy loss evaluation when apparent causes are absent, and the conventional aPLs tests failed to provide interpretations.

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“…Lupus anticoagulant (LA) is an antiphospholipid antibody that binds phospholipids and proteins associated with the cell membrane (1). Phospholipids are essential in vivo because of their biological role in cell membranes and are used in vitro to accelerate coagulation.…”

Section: Introductionmentioning

confidence: 99%

Lupus Antibody Mimicking Reduced Plasmatic Coagulation in a Patient With Atrial Fibrillation and Ischemic Stroke

et al. 2020

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The Lupus Anticoagulant Paradox

Cited by 38 publications

References 69 publications

Low-Molecular-Weight Heparin and Fondaparinux Use in Pediatric Patients With Obesity

Low-Molecular-Weight Heparin and Fondaparinux Use in Pediatric Patients With Obesity

Detection of non‐criteria autoantibodies in women without apparent causes for pregnancy loss

Lupus Antibody Mimicking Reduced Plasmatic Coagulation in a Patient With Atrial Fibrillation and Ischemic Stroke

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