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Lupus Anticoagulant and Stroke

Steven R. Levine, MD; K. M. A. Welch, MD
Arch Neurol. 1987;44(7):691-691. doi:10.1001/archneur.1987.00520190007004
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To the Editor.  —Tabachnik-Schor and Lipton's1 recent report of a case of nonvasculitic cerebral infarction associated with a lupuslike anticoagulant (LA) suggests that their case is the first without "other causes of vasculopathy." Several features of their patient's case do not appear to support their conclusion. Their patient's skin biopsy specimen revealed immune complexes "consistent with a diagnosis of a vasculitis such as systemic lupus erythematosus (SLE)." Further, they state that their patient's stroke was the "first manifestation of vasculitis in a patient with presumptive SLE."Tabachnik-Schor and Lipton state that there are many mechanisms of stroke associated with SLE. Abnormalities of fibrinolysis may also contribute to stroke in SLE,2 and this was not specifically checked for in their patient. Further, cigarette smoking alone can significantly increase the risk of premature stroke3 and, thus, cannot be ignored as a concomitant stroke risk factor in their patient.

REFERENCES

Tabachnik-Schor NF, Lipton SA:  Association of lupuslike anticoagulant and nonvasculitic cerebral infarction . Arch Neurol 1986;;43:851-852.
Dosekun AK, Pollak VE, Glas-Greenwalt P, et al:  Ancrod in systemic lupus erythematosus with thrombosis: Clinical and fibrinolytic effects . Arch Intern Med 1984;;144:37-42.
Bonita R, Scragg R, Stewart A, et al:  Cigarette smoking and risk of premature stroke in men and women . Br Med J 1986;;293:6-8.
Levine SR, Welch KMA:  Cerebrovascular ischemia associated with lupus anticoagulant . Stroke 1987;;8:257-263.
Hart RG, Miller VT, Coull BM, et al:  Cerebral infarction associated with lupus anticoagulants: Preliminary report . Stroke 1984;;15:114-118.

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Tabachnik-Schor NF, Lipton SA:  Association of lupuslike anticoagulant and nonvasculitic cerebral infarction . Arch Neurol 1986;;43:851-852.
Dosekun AK, Pollak VE, Glas-Greenwalt P, et al:  Ancrod in systemic lupus erythematosus with thrombosis: Clinical and fibrinolytic effects . Arch Intern Med 1984;;144:37-42.
Bonita R, Scragg R, Stewart A, et al:  Cigarette smoking and risk of premature stroke in men and women . Br Med J 1986;;293:6-8.
Levine SR, Welch KMA:  Cerebrovascular ischemia associated with lupus anticoagulant . Stroke 1987;;8:257-263.
Hart RG, Miller VT, Coull BM, et al:  Cerebral infarction associated with lupus anticoagulants: Preliminary report . Stroke 1984;;15:114-118.

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