https://doi.org/10.4081/gc.2022.10571
Lupus anticoagulant in an elderly woman with dementia: a clinical case report with many questions and few answers
Submitted: 22 April 2022
Accepted: 6 September 2022
Published: 22 September 2022
Accepted: 6 September 2022
Abstract Views: 523
PDF: 159
HTML: 24
HTML: 24
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
We describe the clinical case of an elderly woman with dementia, suffering from bilateral soleal venous thrombosis, despite antithrombotic prophylaxis, after orthopedic surgery. An isolated anti-cardiolipin antibodies positivity, however pre-existing for at least seven years, was found in a patient with previous cerebral ischemia and treated intermittently with aspirin. During the coronavirus disease 2019 (COVID-19) pandemic lockdown, to promote patient compliance, we practiced anticoagulant therapy with edoxaban: resolution of venous thrombosis was achieved. Longlasting medical treatment is discussed.
Cervera R, Piette JC, Font J, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002;46:1019-27.
DOI: https://doi.org/10.1002/art.10187
Quéméneur T, Lambert M, Hachulla E, et al. Significance of persistent antiphospholipid antibodies in the elderly. J Rheumatol 2006;33:1559-62.
Ruffatti A, Del Ross T, Ciprian M, et al. Risk factors for first thrombotic event in antiphospholipid antibody carriers: a prospective multicenter follow-up study. Ann Rheum Dis 2011;70:1083-6.
DOI: https://doi.org/10.1136/ard.2010.142042
Mustonen P, Lehtonen KV, Javela K, Puurunen M. Persistent antiphospholipid antibody (aPL) in asymptomatic carriers as a risk factor for future thrombotic events: a nationwide prospective study. Lupus 2014;23:1468-76.
DOI: https://doi.org/10.1177/0961203314545410
Pengo V, Testa S, Martinelli I, et al. Incidence of a first thromboembolic event in carriers of isolated lupus anticoagulant. Thromb Res 2015;135:46-9.
DOI: https://doi.org/10.1016/j.thromres.2014.10.013
Grimaud F, Yelnik C, Pineton de Chambrun M, et al. Clinical and immunological features of antiphospholipid syndrome in the elderly: a retrospective national multicenter study. Rheumatology 2019;58:1006-10.
DOI: https://doi.org/10.1093/rheumatology/key437
Pengo V, Del Ross T, Ruffatti A, et al. Lupus anticoagulant identifies two distinct groups of patients with different antibody patters. Thromb Res 2018;172:172-8.
DOI: https://doi.org/10.1016/j.thromres.2018.11.003
Tektonidou MG, Andreoli L, Limper M, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019;78:1296-304.
DOI: https://doi.org/10.1136/annrheumdis-2019-215213
Peleg H, Naparstek Y, Regola F, et al. Can we use NOACS in APS? Autoimmun Rev 2019;18:102408.
DOI: https://doi.org/10.1016/j.autrev.2019.102408
Elsebaie MAT, van Es N, Langston A, et al. Direct oral anticoagulants in patients with venous thromboembolism and thrombophilia: a systematic review and meta-analysis. J Thromb Haemost 2019;17:645-56.
DOI: https://doi.org/10.1111/jth.14398
Pengo V, Denas G, Zoppellaro G, et al. Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood 2018;132:1365-71.
DOI: https://doi.org/10.1182/blood-2018-04-848333
Cerdà P, Becattini C, Iriarte A, et al. Direct oral anticoagulants versus vitamin K antagonists in antiphospholipid syndrome: a meta-analysis. Eur J Intern Med 2020;79:43-50.
DOI: https://doi.org/10.1016/j.ejim.2020.05.012
Pengo V. Oral anticoagulants in thrombotic antiphospholipid syndrome: Leave the old road for a new trial? Eur J Intern Med 2020;79:29-30.
DOI: https://doi.org/10.1016/j.ejim.2020.07.020
Pengo V, Denas G. Diagnostics and treatment of thrombotic antiphospholipid syndrome (APS): A personal perspective. Thromb Res 2018;169:35-40.
DOI: https://doi.org/10.1016/j.thromres.2018.07.011
Williams B, Saseen JJ, Trujillo T, Palkimas S. Direct oral anticoagulants versus warfarin in patients with single or double antibody-positive antiphospholipid syndrome. J Thromb Thrombolysis 2022;54:67-73.
DOI: https://doi.org/10.1007/s11239-021-02587-0
Cattini MG, Bison E, Pontara E, et al. Tetra positive thrombotic antiphospholipid syndrome: major contribution of anti-phosphatidyl-serine/prothrombin antibodies to lupus anticoagulant activity. J Thromb Haemost 2020;18:1124-32.
DOI: https://doi.org/10.1111/jth.14765
Pengo V. Additional laboratory test to improve on the diagnosis of antiphospholipid syndrome. J Thromb Haemost 2020;18:1856-8.
DOI: https://doi.org/10.1111/jth.15026
Tonello M, Bison E, Cattini MG, et al. Anti-phosphatidyl-serine/protrombin antibodies (aPS/PT) in isolated lupus anticoagulant (LA): is their presence linked to dual test positivity? Clin Chem Lab Med 2021;59:1950-3.
DOI: https://doi.org/10.1515/cclm-2021-0692
Ricard L, Laurent C, Papo M, et al. Clinical and prognostic significance of antinuclear antibodies in primary antiphospholipid syndrome: a multicenter retrospective study. Joint Bone Spine 2022;89:105297.
DOI: https://doi.org/10.1016/j.jbspin.2021.105297
AIFA. Nota informativa importante concordata con le Autorità Regolatorie Europee e l’Agenzia Italiana del Farmaco (AIFA). Available from: www.agenziafarmaco.gov.it
Zuily S, Cohen H, Isenberg D, et al. Use of direct oral anticoagulants in patients with thrombotic antiphospholipid syndrome: Guidance from the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost 2020;18:2126-37.
DOI: https://doi.org/10.1111/jth.14935
Regione Lombardia. Percorso Diagnostico, Terapeutico e Assistenziale (PDTA) relativo a: Sindrome da Anticorpi Antifosfolipidi (forma primitiva) - codice esenzione RC0220. A cura degli specialisti della Rete Regionale per le Malattie Rare-Lombardia. Data prima edizione: ottobre 2021. Available from: https://malattierare.marionegri.it/content/view/111/107
Puccetti L, Sammartano V, Calzoni P, et al. Real-life experience of edoxaban treatment for venous thromboembolism (VTE)/pulmonary embolism (PE) in patients with isolated positive Lupus Anticoagulant (LAC) during the COVID-19 pandemic lockdown in Italy. Eur Rev Med Pharmacol Sci 2022;26:54-8.
How to Cite
Turrin, M., Attanasio, A., & Castellaro, I. (2022). Lupus anticoagulant in an elderly woman with dementia: a clinical case report with many questions and few answers. Geriatric Care, 8(2). https://doi.org/10.4081/gc.2022.10571
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.