Dilute Russell's viper venom and activated partial thromboplastin time in lupus anticoagulant diagnosis

Chandrashekar, Vani

doi:10.1097/mbc.0000000000000463

Cited by 9 publications

(13 citation statements)

References 14 publications

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“…A clear benefit of the dRVVT mixing test was not observed in this cohort. This finding adds to the controversial discussion regarding the clinical need for the mixing test, especially in the context of integrated test systems ( 14 – 18 ). Generally, mixing tests might increase the specificity while potentially decreasing the sensitivity by diluting effects of specimens with weak antibodies ( 19 , 20 ).…”

Section: Discussionmentioning

confidence: 67%

Testing lupus anticoagulants in a real-life scenario - a retrospective cohort study

et al. 2017

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IntroductionLupus anticoagulant (LAC) testing is challenging. Most data are derived from a well-controlled study environment with potential alterations to daily routines. The aim of this retrospective cohort study was to assess the capacity of various LAC screening tests and derived mixing tests to predict a positive result in subsequent confirmation tests in a large cohort of patients.Materials and methodsIn 5832 individuals, we retrospectively evaluated the accuracy of the aPTT-A, aPTT-LAscreen, aPTT-FS and dRVVTscreen and of their derived mixing tests in detecting a positive confirmation test result within the same blood specimen. The group differences, degree of correlation and the predictive accuracy of LAC coagulation tests were analysed using the Mann-Whitney U test, the Spearman-rank-correlation and by area under the receiver operating characteristic curve (ROC-AUC) analysis. ROC-AUCs were compared with the Venkatraman´s permutation test.ResultsThe pre-test probability of patients with clinically suspected LAC was 36% in patients without factor deficiency or anticoagulation therapy. The aPTT-LAscreen showed the best diagnostic accuracy with a ROC-AUC of 0.84 (95% CI: 0.82 – 0.86). No clear advantage of the dRVVT-derived mixing test was detectable when compared to the dRVVTscreen (P = 0.829). Usage of the index of circulating anticoagulant (ICA) did not improve the diagnostic power of respective mixing tests.ConclusionsAmong the parameters evaluated, aPTT-LAscreen and derived mixing test parameters were the most accurate tests. In our study cohort, neither other mixing test nor the ICA presented any further advantage in LAC diagnostics.

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Section: Discussionmentioning

confidence: 67%

Testing lupus anticoagulants in a real-life scenario - a retrospective cohort study

et al. 2017

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“…Whether or not mixing tests are required for accurate detection of LA, and whether they should be performed before or after the confirmatory test, remains a matter of ongoing debate. [5][6][7][8][9][10] In principle, all coagulation tests that investigate phospholipid-dependent coagulation reactions are suitable for detection of LA, provided the phospholipid concentration in the reagent is low enough to be sensitive for LA. These include dilute prothrombin time (PT), activated partial thromboplastin time (aPTT) variants, and tests that involve snake venom coagulation activators, such as the textarin time, 11 the Taipan snake venom time, 12 or the dilute Russell's viper venom time (dRVVT).…”

Section: Detection Of Lupus Anticoagulantmentioning

confidence: 99%

The Lupus Anticoagulant Paradox

Molhoek

Groot

Urbanus

2017

Semin Thromb Hemost

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Lupus anticoagulant (LA) represents the most enigmatic antibody population in patients with antiphospholipid syndrome and represents a paradox that is still unsolved. This class of antiphospholipid antibody causes a phospholipid-dependent prolongation of the clotting time but is associated with an increased risk of thrombosis and pregnancy morbidity. In this review, we will provide an overview of the different antibodies that have been associated with LA activity, their importance based on clinical studies, and address the question why this prolongation of the clotting time is associated with thrombosis rather than a bleeding tendency.

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“…Despite recommendations in earlier as well as current guidelines, many laboratories have limited their APTT testing to screen and mix tests only, further restricting specificity of that assay system [22,49]. Indeed, the design and interpretation of the previously widely used kaolin clotting time, an APTT modification, is predicated on mixing test results [1,10].…”

Section: Confirmatory Testsmentioning

confidence: 99%

Current Controversies in Lupus Anticoagulant Detection

Moore

2016

Antibodies

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Antiphospholipid syndrome is an autoimmune, acquired thrombophilia diagnosed when vascular thrombosis or pregnancy morbidity are accompanied by persistent antiphospholipid antibodies. Lupus anticoagulants (LA) are one of the criteria antibodies but calibration plasmas are unavailable and they are detected by inference based on antibody behaviour in a medley of coagulation-based assays. Elevated screening tests suggest the presence of a LA, which is confirmed with mixing tests to evidence inhibition and confirmatory tests to demonstrate phospholipid-dependence. At least two screening tests of different principle must be used to account for antibody heterogeneity and controversy exists on whether assays, in addition to dilute Russell's viper venom time and activated partial thromboplastin time, should be employed. A variety of approaches to raw data manipulation and interpretation attract debate, as does inclusion or exclusion of mixing studies in circumstances where the presence of a LA is already evident from other results. Therapeutic anticoagulation compromises coagulation-based assays but careful data interpretation and use of alternative reagents can detect or exclude LA in specific circumstances, and this aspect of LA detection continues to evolve. This review focuses on the main areas of debate in LA detection.

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Dilute Russell's viper venom and activated partial thromboplastin time in lupus anticoagulant diagnosis

Cited by 9 publications

References 14 publications

Testing lupus anticoagulants in a real-life scenario - a retrospective cohort study

Testing lupus anticoagulants in a real-life scenario - a retrospective cohort study

The Lupus Anticoagulant Paradox

Current Controversies in Lupus Anticoagulant Detection

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