Profils clinico-biologiques associés à la présence d’un lupus anticoagulant de faible intensité : quelle prise en charge adopter ?

Abstract : The antiphospholipid syndrome (APS) is characterized by the association of thrombosis or obstetrical events with the persistence of antiphospholipid antibodies (aPL), including the lupus anticoagulant (LA). However, when LA is weak, its involvement in the occurrence of clinical events is discussed. In order to determine the clinical and-biological characteristics associated with the presence of a weak LA, we studied data from 114 patients sampled between 01/09/2016 and 31/08/2017 for which only the diluted Russell viper venom time (dRVVT) was positive with a Lupus AntiCoagulant ratio (LAC ratio) of low intensity (between 1.20 and 1.30 inclusive), followed the evolution of LA over time and analyzed the patient care proposed by the clinicians. The weak LA accounted for 27,5% of LA-positives over this period. The association with other aPL, anti-cardiolipin and anti-β2 glycoprotein-I antibodies, was not found in 98 patients (86,0%). The presence of LA, on at least two samples more than 12 weeks apart, was confirmed in 25 patients (54,4% of controlled patients) of which 14 (56,0%) presented clinical events of SAPL. Of the 25 patients, 13 (52,0%) had LA kinetics that were difficult to interpret because of unexplained negations. The LA was considered by the clinician in 18 (72,0%) of the 25 patients and 13 of them received treatment in primary or secondary prophylaxis. However, 21 patients (45,7% of controlled patients) had their LA disappeared and 68 patients with a weak LA (59,6%) were not controlled or would require a new control. These results confirm the presence of persistent weak LA associated with clinical signs of SAPL justifying appropriate treatment however, considering the diversity of clinical and biological profiles highlighted, the patient care remains controversial.
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Master Thesis
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Submitted on : Friday, April 5, 2019 - 5:29:31 PM
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Diana Ramaharo Ratiarison. Profils clinico-biologiques associés à la présence d’un lupus anticoagulant de faible intensité : quelle prise en charge adopter ?. Médecine humaine et pathologie. 2018. ⟨dumas-02091489⟩

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