Lupus anticoagulant in patients with peripheral vascular disease: a prospective study.
OBJECTIVE
To assess the incidence of lupus anticoagulant (LAC) in patients with peripheral vascular disease.


METHODS
Prospective clinical study.


METHODS
University Hospital.


METHODS
20 patients with claudication (group 2), 20 patients with critical ischaemia (group 3) and 20 patients prior to elective abdominal aortic aneurysm surgery (group 4) were compared to 20 general surgical controls (group 1).


METHODS
Venous blood samples for coagulation assay.


RESULTS
Positive results for LAC by the Dilute Russell's viper venom time (DRVVT) with the platelet neutralisation procedure were present in 26 out of 60 vascular patients compared with none of the 20 general surgical controls. The three vascular groups showed a similar prevalence of LAC and this differed significantly from that in the control group (chi 2 = 10.94, p = 0.0009). Of the 26 positive results only three were associated with an abnormal activated partial thromboplastin time (APTT), which has previously been used as a marker for the presence of LAC activity. Fibrinogen levels were raised in seven of 20 patients in group 2 but were normal in the remaining vascular groups (p = 0.001). The mean factor VII level (124.1 units dl-1) in group 2 was higher than the mean of the remaining vascular patients (109.3 units dl-1, p < 0.05).


CONCLUSIONS
The high prevalence of LAC in patients with peripheral vascular disease and the associated increased risk of early graft thrombosis may justify routine testing by DRVVT prior to reconstructive vascular surgery. Treatment of these patients with antiplatelet agents or formal anticoagulation perioperatively should be considered.
Fligelstone
L J
LJ
Cardiff Vascular Unit, University Hospital of Wales, Heath Park, U.K.
Cachia
P G
PG
Ralis
H
H
Whattling
P
P
Morgan
R H
RH
Shandall
A A
AA
Lane
I F
IF
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000276:immunology; D001780:Blood Coagulation Tests; D016022:Case-Control Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007383:Intermittent Claudication / Q000097:blood / Q000276:immunology; D007511:Ischemia / Q000097:blood / Q000276:immunology; D016682:Lupus Coagulation Inhibitor / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood* / Q000276:immunology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology
D016682:Lupus Coagulation Inhibitor