In rare cases of lupus anticoagulant causing bleeding tendency, immunosuppressants can correct aPTT, and vitamin K antagonists are a safe initial option for subsequent anticoagulation needs such as atrial fibrillation.
Immunosuppressants may rapidly normalize aPTT in rare bleeding cases; leaves open optimal anticoagulation strategies pending higher-level evidence.
Key Clinical Message: Lupus anticoagulant caused aPTT prolongation in rare case can cause bleeding tendency especially when combined with other hemostasis abnormalities. In such cases, aPTT value can be corrected by immunosuppressants within several days of treatment. When anticoagulation therapy is needed vitamin K antagonist are a good option for the initial treatment. Abstract: Lupus anticoagulant antibodies despite causing aPTT prolongation are commonly associated with increased risk of thrombosis. We present a rare case of patient when these autoantibodies resulted in dramatic aPTT prolongation and combined with associated thrombocytopenia resulted in minor bleeding events. In presented case treatment with oral steroids resulted in aPTT values correction followed by resolution of bleeding tendency within several days. Later, the patient developed chronic atrial fibrillation and was started on anticoagulation treatment initially with vitamin K antagonist without bleeding complications during follow-up period. Corresponding changes in patient's aPTT time in a course of whole treatment is presented.
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Frydrysiak et al. (2023) studied this question.
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