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Background  Lupus anticoagulant ( LA ) is classified in the antibody family that is recognized in antiphospholipid syndrome. Mixing tests are recommended for  LA  detection, and either a mixing test–specific cutoff ( MTC ) or index of circulating anticoagulant ( ICA ) is used for the interpretation. Although we previously showed  MTC  had higher sensitivity for  LA  than  ICA , there are few studies investigating specificity.    Objectives  To investigate specificity of multiple  activated partial thromboplastin time (APTT)  and  diluted Russell's viper venom time (dRVVT ) reagents for inhibitors using plasmas with non‐ LA  causes of prolonged clotting times, interpreted with  MTC  and  ICA .    Methods  Seventy‐six factor‐deficient samples (either artificially prepared, hereditary deficiency, or warfarin), and 12 inhibitors (either coagulation factor inhibitors, rivaroxaban, or apixaban) were used. Samples were tested with 4  APTTs , 1 dilute  APTT  ( dAPTT ), and 2  dRVVT  reagents, and all elevated screen ratios were followed up with mixing tests. Frequencies of corrected and not‐corrected results were calculated.    Results  The frequency of  MTC  and  ICA  corrected results, suggesting factor deficiency, were 5% to 43% and 79% to 100%, respectively, except for  dAPTT,  where  MTC  and  ICA  performed similarly. Frequencies of  MTC  and  ICA  not‐corrected results, suggesting inhibition, were 29% to 100% and 25% to 67%, respectively.    Conclusions  The data indicate that  MTC  has a tendency to generate not‐corrected mixing tests in factor‐deficient, warfarin, and other inhibitor samples, while  ICA  exhibited higher specificity. When we perform the mixing test and interpret the data, it is important to understand the characteristics of the indexes for maximizing the diagnostic potential of mixing test.

Ruling out lupus anticoagulants with mixing test–specific cutoff assessment and the index of circulating anticoagulant