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
Abstract Views: 499
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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.

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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