Prosthetic Graft Thrombosis Associated with Lupus Anticoagulant

The presence of an unique in vitro coagulation inhibitor in two patients with systemic lupus erythematosis (SLE) was first described by Conley and Har tmann (1952). 1 A similar phenomenon in a patient without SLE was subsequently described by Frick (1955). 2 The term "lupus anticoagulant" (LA) was introduced in 19 72 by Feinstein and Rapaport. 3 For the clinician the term "lupus ant icoagulant" is misleading because this inhibitor of coagulation tests only rarely interferes with haemostasis in vivo. Furthermore it is not confined to patients with lupus. Its clinical implications, paradoxically,, are concerned with spontaneous venous and arterial thrombosis. 4 The identification of lupus anticoagulant is hallmarked by the prolongation of phospholipid-dependent coagulation tests, which are not corrected by the addition of normal plasma but which will become normal with the addition of platelet phospholipid. This is due to the action of immunoglobulins of the IgG or IgM class, with affinity for phospholipid (platelet factor III), s hence the alternative term "lupus antibody". We report two patients with peripheral vascular disease who underwent aorta-bifemoral and femoropopliteal bypass respectively, who were incidentally found to have LA. Both procedures were technically straightforward and a successful outcome was anticipated. Both patients suffered from unexpected-and in one case repeated--graf t thrombosis. We have been unable to find similar cases reported within the literature.