Does Systemic Lupus Erythematosus (SLE) increase the risk of thrombosis?

From the Guidelines

Yes, Systemic Lupus Erythematosus (SLE) does increase the risk of thrombosis, particularly in patients with antiphospholipid antibodies (aPLA), which are found in about 30% of patients with SLE. This increased risk is due to several factors related to the disease, including inflammation of blood vessels (vasculitis), which damages vessel walls and promotes clot formation, and the development of antiphospholipid antibodies, which attack proteins involved in blood clotting and make the blood more likely to clot abnormally 1.

Key Factors Contributing to Thrombosis Risk in SLE

• Inflammation of blood vessels (vasculitis)
• Development of antiphospholipid antibodies
• Lupus flares increasing inflammation throughout the body
• Certain medications used to treat lupus, such as corticosteroids

Management and Prevention Strategies

• Patients with SLE should be aware of blood clot symptoms, including swelling, pain, and warmth in the legs; chest pain; shortness of breath; or sudden severe headache
• Those with additional risk factors like smoking, pregnancy, or a family history of clots should discuss preventive strategies with their healthcare provider
• Preventive strategies might include blood thinners like aspirin or anticoagulants in certain cases, with warfarin being recommended for long-term anticoagulation in patients with APS nephropathy 1
• The use of direct oral anticoagulants is not recommended due to their inferiority to warfarin in preventing thromboembolic events in this setting 1

Guideline Recommendations

• The 2019 update of the EULAR recommendations for the management of SLE suggests that patients with SLE and aPL may receive additional anticoagulant treatment, such as low-molecular weight heparin, during high-risk periods for thrombosis (pregnancy or postoperatively) 1
• The GLADEL-PANLAR recommendations for adult patients with SLE with antiphospholipid antibodies or antiphospholipid syndrome suggest the use of extended over time-limited anticoagulation and standard-intensity anticoagulation (INR 2.0-3.0) over high-intensity anticoagulation (INR 3.0-4.0) 1

From the Research

Systemic Lupus Erythematosus and Thrombosis Risk

• Systemic Lupus Erythematosus (SLE) is associated with an increased risk of thrombosis, as evidenced by multiple studies 2, 3, 4, 5, 6.
• The presence of antiphospholipid antibodies, such as lupus anticoagulant and anticardiolipin antibodies, is a significant risk factor for thrombosis in SLE patients 2, 3, 5.
• Factor V Leiden, a genetic disorder, is also a risk factor for venous thrombosis in SLE patients, although its prevalence is similar to that in the general population 2, 6.

Risk Factors for Thrombosis in SLE

• Antiphospholipid antibodies, particularly lupus anticoagulant, are independent risk factors for both arterial and venous thrombosis 2, 3.
• High triglycerides, hereditary thrombophilia, and hypertension are also associated with an increased risk of venous and arterial thrombosis, respectively 3, 4.
• Superficial vein thrombosis and history of arterial thrombosis are significant predictors of thromboembolic events in SLE patients 4.
• Activated partial thromboplastin time and proteinuria are also associated with an increased risk of thrombosis in SLE patients 5.

Thrombosis Risk in SLE Patients with Antiphospholipid Antibodies

• SLE patients with antiphospholipid antibodies have a higher risk of thrombosis compared to those without these antibodies 3, 5.
• The risk of thrombosis remains elevated over time in SLE patients with antiphospholipid antibodies 5.
• The presence of factor V Leiden mutation may increase the risk of thrombosis in SLE patients with antiphospholipid antibodies, although this association is not statistically significant 6.