The Effects of Indirect- and Direct-Acting Anticoagulants on Lupus Anticoagulant Assays: A Large, Retrospective Study at a Coagulation Reference Laboratory

American Journal of Clinical Pathology
Jansen N SeheultIrina Chibisov

Abstract

To investigate the effects of indirect- and direct-acting anticoagulants on the interpretation of lupus anticoagulant (LAC) assays. A retrospective database review was performed to identify all LAC panels from November 2012 to November 2015. The positivity rates for three LAC tests were compared among various anticoagulant medications. This analysis included 7,721 LAC panels. Direct oral anticoagulants, warfarin, and unfractionated heparin (UFH) were associated with higher LAC positivity rates compared with patients not receiving documented anticoagulation (83% for argatroban, 58% for dabigatran, 72% for rivaroxaban, 53% for apixaban, 56% for warfarin, and 36% for UFH vs 29% for no anticoagulation, P < .025). Direct thrombin inhibitors mainly affected the activated partial thromboplastin time-based assays and the tissue thromboplastin inhibition index (TTI), while direct factor Xa inhibitors mainly affected the TTI and the dilute Russell viper venom ratio. Results of LAC testing performed while patients are receiving anticoagulant therapies should be interpreted with caution to avoid misdiagnosing patients with the antiphospholipid syndrome and potentially committing them to long-term anticoagulation therapy.

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Citations

Apr 7, 2018·Journal of Thrombosis and Haemostasis : JTH·H CohenD A Isenberg
Mar 19, 2019·American Journal of Hematology·Julian A Villalba, Elizabeth M Van Cott
May 14, 2020·Journal of Thrombosis and Haemostasis : JTH·Pieter M De Kesel, Katrien M J Devreese
Apr 16, 2020·Journal of Thrombosis and Haemostasis : JTH·Andreas HillarpTomas L Lindahl
Jan 29, 2020·Research and Practice in Thrombosis and Haemostasis·Pieter M M De Kesel, Katrien M J Devreese
May 30, 2020·British Journal of Hospital Medicine·Stephen BoothMichael Desborough
Dec 24, 2018·Transfusion Medicine and Hemotherapy : Offizielles Organ Der Deutschen Gesellschaft Fur̈ Transfusionsmedizin Und Immunham̈atologie·Yasmin KamelKhaled Yassen
Mar 19, 2021·Research and Practice in Thrombosis and Haemostasis·Steven Andrew BakerJames L Zehnder
Jul 5, 2021·Current Rheumatology Reports·Thomas ForetDenis Wahl

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