LUPUS ANTICOAGULANT IN PATIENTS WITH PERIPHERAL VASCULAR-DISEASE - A PROSPECTIVE-STUDY

Objective: To assess the incidence of lupus anticoagulant (LAG) in pat ients with peripheral vascular disease. Design: Prospective clinical s tudy. Setting: University Hospital. Materials: 20 patients with claudi cation (group 2), 20 patients with critical ischaemia (group 3) and 20 patients prior to elective abdominal aortic aneurysm surgery (group 4 ) were compared to 20 general surgical controls (group 2). Chief outco me measures: Venous blood samples for coagulation assay. Main results: Positive results for LAC by the Dilute Russell's viper venom time (DR VVT) with the platelet neutralisation procedure were present in 26 out of 60 vascular patients compared with none of the 20 general surgical controls. The three vascular groups showed a similar prevalence of LA C and this differed significantly from that in the control group (chi( 2)=10.94, p=0.0009). Of the 26 positive results only three were associ ated with an abnormal activated partial thromboplastin time (APTT), wh ich has previously been used as a marker for the presence of LAC activ ity. Fibrinogen levels were raised in seven of 20 patients in group 2 but were normal in the remaining vascular groups (p=0.002). The mean f actor VII level (124.1 units dl(-1)) in group 2 was higher than the me an of the remaining vascular patients (109.3 units dl(-1), p<0.05), Co nclusions: The high prevalence of LAC in patients with peripheral vasc ular disease and the associated increased risk of early graft thrombos is may justify routine testing by DRVVT prior to reconstructive vascul ar surgery Treatment of these patients with antiplatelet agents or for mal anticoagulation perioperatively should be considered.