Premium
Lupus anticoagulant detection in anticoagulated patients. Guidance from the Scientific and Standardization Committee for lupus anticoagulant/antiphospholipid antibodies of the International Society on Thrombosis and Haemostasis
Author(s) -
Tripodi Armando,
Cohen Hannah,
Devreese Katrien M. J.
Publication year - 2020
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.14846
Subject(s) - lupus anticoagulant , medicine , antiphospholipid syndrome , systemic lupus erythematosus , thrombosis , heparin , low molecular weight heparin , anticoagulant , immunology , intensive care medicine , disease
Background The laboratory detection of lupus anticoagulants (LA) in anticoagulated patients represents a challenge and there is no consensus on the types of assays/procedures to be adopted. Objectives This communication of the International Society on Thrombosis and Haemostasis (ISTH), Scientific and Standardization Committee (SSC) aims to give guidance on the procedures to be adopted. Methods Members of the ISTH‐SSC on Lupus Anticoagulant/Antiphospholipid Antibodies reviewed the literature to search for evidence on the most appropriate assays/procedures to be adopted. Results Anticoagulants are able to interfere with the tests used for LA detection, giving rise to occasional false‐positive or false‐negative LA. Some commercial tests include in their composition heparin‐neutralizers able to quench unfractionated or low molecular weight heparin up to 1.0 U/mL. LA tests are less affected by low molecular weight heparin, but caution is needed in the interpretation of results. Vitamin K antagonists (VKAs) may affect LA detection. Dilution of test plasma into pooled normal plasma is not a reliable solution as false‐negative or false‐positive LA may occur. Direct oral anticoagulants (DOACs) affect LA detection. Hence, it is not recommended to attempt LA detection in those patients. The use of DOAC adsorbents is a promising solution and should be further investigated on LA‐positive and LA‐negative patient populations. Taipan/Ecarin tests may be a solution for VKAs and anti‐FXa DOACs, but independent evidence on their value and standardized kits is needed. Conclusions LA detection during anticoagulation remains a challenge, especially for VKAs. DOAC removal by in vitro addition to plasma of appropriate absorbents is promising.