Anticoagulants and Lupus

Anticoagulants are an important tool for maintaining heart, lung, and brain health for people with lupus.

Blood clots are a major issue for people with lupus. People with systemic lupus erythematosus (SLE) are at higher risks of strokes, heart attacks, embolisms, and are more likely to have poor outcomes both physically and mentally. These can be very severe, and even the eyes can be affected. 

Why are Lupus Warriors more susceptible to blood clots? The answer lies both in the inflammation caused by lupus and certain lupus medications. Both make cells in blood vessels and arteries more likely to be damaged, which can cause platelets and other particles in the bloodstream to build up and clots to form. Lupus also interferes with clotting directly and may be associated with certain clotting antibodies that clot more quickly and easily.

3.1% of people with lupus experienced some time of stroke according to studies, and heart attacks and stroke account for 20-30% of deaths in SLE.  This makes anti-clotting medications an important addition to the medication regimen of many Lupus Warriors.

What are Anticoagulants?

Anticoagulants, also known as “blood thinners” are medications that help prevent blood clots. Blood clots are the body’s way to stop bleeding, plugging up wounds as a sort of natural band-aid so that the body can heal. However, when they form in the wrong place, they can prevent blood from flowing to vital organs, starving them of oxygen. When blood clots block off blood vessels leading to the brain, heart, and lungs, they cause heart attacks, strokes, and pulmonary embolisms respectively. Anticoagulants interrupt the clotting process midway, preventing the clot from forming. Generally, these are prescribed when a person’s blood makes clots too often or is at a high risk of doing so.

Types of Anticoagulants

There are many types of anticoagulants available for people with lupus. According to Johns Hopkins, Warfarin, Heparin, Dalteparin, Danaparoid, Enoxaparin, Tinzaparin, and Fondaparinux are the ones most commonly used for lupus.

 Vitamin K Antagonists

Vitamin K antagonists prevent the body from processing vitamin K, a nutrient found mainly in green leafy vegetables and produced to a limited extent in the body. It’s easy to get enough vitamin k through a balanced, healthy diet.  Vitamin K is broken down or otherwise used by the body to build blood clotting and bone-building materials in the body. 

Antagonists prevent the body from breaking down vitamin K and turning them into clotting factors. This leads to the body not being able to produce as much clotting factors. 

Vitamin K antagonists can be reversed in an emergency with an injection of vitamin k (in fact, this is often given to newborn infants to help them properly make live-saving clots!) However, they also require you to keep your diet consistent because the correct dose depends on how much vitamin k you are taking in.

Warfarin is a vitamin K antagonist that is taken orally.

Direct Oral Anticoagulants (DOACs)

Other anticoagulants interfere more directly. Blood clots are formed when a series of enzyme interactions occur in the bloodstream to create a mesh that catches and holds back blood cells. This process has many steps. Direct Oral Anticoagulants target the clotting process itself, preventing the next step from occuring and stopping the clot mid-formation. 

Dabigatran, apixaban, edoxaban, and betrixaban are all DOACs.

What is Lupus Anticoagulant?

People with lupus often take anticoagulant medications, but when you look for information, it can get confusing because of the presence of ‘lupus anticoagulants.’ Although both anticoagulant medications and lupus anticoagulants are involved with how and when blood clots form, they are not the same.

Lupus anticoagulants are antibodies in the blood that are associated with blood clotting disorders. Antiphospholipid antibody tests are how doctors test for them. 50% of people with lupus have these antibodies in their bloodstream and are at higher risk of clotting disorders. Clotting disorders related to these antibodies can happen even when the symptoms of lupus are otherwise well controlled or in remission so it is important to also treat the clotting as well.  

Knowing whether you have these antibodies can help your treatment team better prepare and medicate for clotting problems, but can also be a part of diagnosing lupus. 

Things to Keep in Mind with Anticoagulants

Anticoagulants prevent blood from clotting in the wrong places or at the wrong times. Unfortunately, this also means that blood also becomes less likely to clot in the right places or times, which can lead to bleeding and poor wound healing. Usually, if you are being prescribed anticoagulants, it is because your treatment team has weighed the risks of bleeding versus the benefits of lower risks of stroke and heart attack. However, it is a notable side effect that you should definitely keep an eye out for.

This bleeding can be external, such as an injury that breaks the skin or even a bruise, or internal. Anticoagulants also effect periods, leading to heavier periods. You can read more about lupus and menstruation here. These side effects be dangerous if the bleeding goes on too long or the damage is not healed by the body. 

For this reason, doctors and surgeons often advice people to stop taking anticoagulants for a short period of time before the surgery to protect against bleeding. Anticoagulants are also not good for pregnant women. 

As always, consult with your treatment team before stopping use, but let them know if you are about to have surgery or are about to be pregnant.