From the Guidelines
Drug-induced lupus (DIL) is not typically associated with a hypercoagulable state. Unlike systemic lupus erythematosus (SLE), which can cause antiphospholipid syndrome and increase thrombosis risk, DIL generally does not produce the autoantibodies responsible for hypercoagulability. The pathophysiology of DIL involves drug-induced autoantibody production against histones and other nuclear components, but these antibodies differ from those in SLE that promote clotting, as discussed in the 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus 1. When DIL is suspected, the causative medication should be discontinued, which typically leads to symptom resolution within weeks to months. If a patient with DIL shows signs of abnormal clotting, other causes should be investigated, as this would be unusual for drug-induced lupus alone and might indicate coexisting conditions or the rare development of SLE-like complications. Key considerations for managing patients with SLE and antiphospholipid antibodies or antiphospholipid syndrome are outlined in the GLADEL–PANLAR recommendations 1, but these are not directly applicable to DIL due to its distinct pathophysiology. In clinical practice, the focus for DIL should remain on discontinuing the offending medication and monitoring for potential complications, rather than assuming an increased risk of thrombosis based on the presence of DIL alone. It is essential to differentiate DIL from SLE and other conditions that may cause hypercoagulability to provide appropriate management and minimize the risk of morbidity and mortality. The primary goal in managing DIL is to improve the patient's quality of life by resolving symptoms and preventing potential complications, which can be achieved through prompt discontinuation of the causative medication and careful monitoring.
From the Research
Drug-Induced Lupus and Hypercoagulable State
- There is no direct evidence in the provided studies that drug-induced lupus causes a hypercoagulable state.
- However, some studies suggest that certain autoantibodies associated with drug-induced lupus, such as anti-cardiolipin antibodies and lupus anticoagulant, can be present in some patients 2.
- These autoantibodies are known to be associated with an increased risk of thrombosis and hypercoagulability in other contexts, but their role in drug-induced lupus is not well established.
- One study found that 42% of patients with hydralazine-induced lupus had positive anti-cardiolipin antibodies and lupus anticoagulant, which could potentially contribute to a hypercoagulable state 2.
- Further research is needed to determine the relationship between drug-induced lupus and hypercoagulability, as the current evidence is limited and indirect.