Thrombosis in systemic lupus erythematosus. Relation to the presence of circulating anticoagulants

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Abstract
In an earlier report on the kidney in systemic lupus erythematosus (SLE), a subset of patients with circulating anticoagulant were described; many of whom had glomerular and arteriolar thrombosis in the absence of necrosis and subendothelial deposits. The present study extends these observations to a larger group of patients with SLE and a circulating anticoagulating and compares its findings with those in patients with SLE without evidence of an anticoagulant. It demonstrates: a high prevalence of clinically recognizable thrombotic events in the venous and arterial circulations in patients with SLE and a detectable anticoagulant; a probable shortening in life span; a higher prevalence of glomerular thrombi; elevated levels of factor VIII antigen and von Willebrand factor; significantly lower platelet counts and decreased in vitro platelet aggregation in response to ADP, epinephrine and collagen. Since prednisone treatment often results in improvement or disappearance of a prolonged partial thromboplastin time, the test most commonly used for screening of a circulating anticoagulant, the prevalence of this abnormality may be underestimated in patients with SLE.