Medication for positive Lupus Anticoagulant

[lindaromano]

I've had 2 strokes and tested positive for the Lupus Anticoagulant. Is Coumadin the best or only option for this?  Are Plavix or Aggrenox Options?
Thank-you,
Linda Romano

[Dr Rajgopal]

Hi Linda,
The lupus anticoagulants usually interfere with blood clotting and are also factors for thrombosis. Patients with a lupus anticoagulant are prone to excess bleeding, repeated miscarriages, thrombosis and strokes. Patients with a lupus anticoagulant that presents atleast twice and a history of thrombosis should be given indefinite treatment with anticoagulants. Thrombosis can be prevented with heparin administration and treated with heparin and warfarin. If clots occur  heparin followed by warfarin ( coumadin )is usually prescribed. Higher-than-usual doses of warfarin may be needed. Warfarin or Coumadin is prescribed to prevent strokes arising from atrial fibrillation and  DVTs forming in the legs usually. Blood clots that form in veins (deep vein thrombosis, pulmonary embolism) are mainly made up of clotting proteins and platelets do not play a significant role in venous clots. Coumadin or warfarin is an effective blood thinner that prevens the production of clotting factors in the liver. Anti-platelet drugs like Aspirin or Plavix do not play much of a role in preventing venous clots.

However, in persons with the lupus anticoagulant, the risk of recurrence of both arterial and venous thrombotic episodes is very high. Some patients may need to be on long-term  oral anticoagulation. Some may need to be on anticoagulation for the whole life.
Plavix, similar to Aspirin, is an antiplatelet drug and is effective in treating arterial clots (in cases of stroke, heart attack, peripheral arterial disease). Plavix stops platelets aggregation or prevents them from sticking together. This tends to prevent clot formation in the arteries, including coronary arteries or the arteries on the surface of heart.
Aggrenox (aspirin/extended-release dipyridamole) is indicated to reduce the risk of stroke in patients who have had transient ischemia of the brain or completed ischemic stroke due to thrombosis.
Though the drugs of choice for a lupus anticoagulant are heparin and warfarin (coumadin), Plavix may be administered additionally to prevent arterial thrombotic episodes. Aggrenox has the same action as Coumadin. The choice of drug and management plan differs with different doctors and the risk factors of the patient. Please discuss the management plan with your doctor. Hope this helps you. Take care and regards!  

[lindaromano]

Thank-you Doctor for your response and detailed information. You gave me a clear understanding on what I needed to know.
Take care and thank-you for your time.
Linda Romano