Monitoring of anticoagulation in thrombotic antiphospholipid syndrome

Cohen, Hannah; Efthymiou, Maria; Devreese, Katrien

doi:10.1111/jth.15217

Cited by 25 publications

(24 citation statements)

References 113 publications

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“…7 However, guidance from scientific societies is variable about the use of DOACs in APS, and states that these drugs should not be used in high-risk patients (arterial thrombosis, triple positivity to aPL, small vessel thrombosis, and heart valve disease), non-adherent patients, or those with recurrent thrombosis while on therapeutic intensity VKA. [8][9][10][11] Therefore, anticoagulation with a VKA remains the standard of care for treating APS patients. 12 The laboratory test used for monitoring VKA anticoagulation is prothrombin time (PT), a worldwide, standardized coagulation test, expressed as international normalized ratio (INR).…”

Section: Introductionmentioning

confidence: 99%

“…The use of POC should be considered only if the difference between POC and venous INR are <0.5. 11 Nevertheless, there is a lack of information regarding CoaguChek XS performance in APS patients.…”

Section: Introductionmentioning

confidence: 99%

“…24 The World Health Organization (WHO) has recommended the inclusion of plasmas with INRs 1.5–4.5 for the calibration of the thromboplastin ISI 25 and, then, POC INR system can be valid up to an INR of 4.5. 11 Thus, a pragmatic approach is recommended for APS patients, checking the agreement between POC and reference laboratory INRs. Venous INR should be assessed initially at baseline and every 6–12 months.…”

Section: Introductionmentioning

confidence: 99%

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CoaguChek® XS versus standard laboratory prothrombin time for anticoagulant monitoring in patients with antiphospholipid syndrome

Fonseca

Balbi

Signorelli

et al. 2022

Lupus

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Introduction The standard of care for thrombotic antiphospholipid syndrome (APS) is anticoagulation with vitamin K antagonists (VKAs). Prothrombin time, and its corresponding international normalized ratio (INR), is the laboratory test routinely performed to assess anticoagulation. Self-management of VKA therapy using point-of-care (POC) devices seems to be an attractive option. Purpose/objective To evaluate the accuracy of a POC device (CoaguChek XS) in APS patients by comparing it with venous laboratory INR. Furthermore, we analyzed whether other clinical and laboratory features could interfere with the CoaguChek XS results. Patients and methods This is a single-center cross-sectional study with 94 APS patients from a tertiary rheumatology clinic performed from August 2014 to March 2015. The comparison between CoaguChek XS and venous laboratory INR results was evaluated using the coefficient of determination (r) followed by the Bland–Altman test. A paired t-test was also applied. A difference of up to ±0.5 INR unit between the two systems was considered clinically acceptable. Results The mean CoaguChek-INR was 2.94 ± 1.41 and venous laboratory INR was 2.43±0.86, with a correlation coefficient (r) of 0.95. Categorizing INR values in ranges (INR <2, INR 2–3, INR 3–4, and INR >4), we found that the INR >4 group presented a lower correlation (r = 0.64) compared to the other ranges ( p < 0.05). Although both methods were highly correlated, CoaguChek XS showed higher values than the venous laboratory INR, with an increased average of 0.42 ± 0.54. Therefore, we proposed a simple linear regression model to predict the venous laboratory INR values, using results obtained from CoaguChek XS. A difference ≤0.5 INR unit between the two systems was observed in 57.4% of patients, and the aPL profile did not influence the results. Conclusion Although CoaguChek XS and venous laboratory INR demonstrated a good linear correlation in the group of INR ≤4, extra caution should be taken in APS patients, since a reasonable proportion of patients can present differences in INR results that are not acceptable. We do not recommend routine POC in APS patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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CoaguChek® XS versus standard laboratory prothrombin time for anticoagulant monitoring in patients with antiphospholipid syndrome

Fonseca

Balbi

Signorelli

et al. 2022

Lupus

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“…107 108 109 There is an inverse linear relationship between chromogenic assay-derived FX level and INR, with a FX activity therapeutic range of 20 to 40% broadly correlating with an INR range between 2.0 and 3.0. 108 110 111 The assay is less useful for INRs ≥ 3.5, probably due to interference by undercarboxylated FX when the level of fully functional FX is markedly reduced. 111 112 The chromogenic FX assay can also be useful when transitioning patients from an anticoagulant that interferes with INR testing to VKA anticoagulation, 113 114 and when patients have other causes of elevated PT/INR, such as dysfibrinogenemia.…”

Section: Factor Assaysmentioning

confidence: 99%

“…108 110 111 The assay is less useful for INRs ≥ 3.5, probably due to interference by undercarboxylated FX when the level of fully functional FX is markedly reduced. 111 112 The chromogenic FX assay can also be useful when transitioning patients from an anticoagulant that interferes with INR testing to VKA anticoagulation, 113 114 and when patients have other causes of elevated PT/INR, such as dysfibrinogenemia. 115…”

Section: Factor Assaysmentioning

confidence: 99%

Snake Venoms in Diagnostic Hemostasis and Thrombosis

Moore

2021

Semin Thromb Hemost

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Snake venoms have evolved primarily to immobilize and kill prey, and consequently, they contain some of the most potent natural toxins. Part of that armory is a range of hemotoxic components that affect every area of hemostasis, which we have harnessed to great effect in the study and diagnosis of hemostatic disorders. The most widely used are those that affect coagulation, such as thrombin-like enzymes unaffected by heparin and direct thrombin inhibitors, which can help confirm or dispute their presence in plasma. The liquid gold of coagulation activators is Russell's viper venom, since it contains activators of factor X and factor V. It is used in a range of clotting-based assays, such as assessment of factor X and factor V deficiencies, protein C and protein S deficiencies, activated protein C resistance, and probably the most important test for lupus anticoagulants, the dilute Russell's viper venom time. Activators of prothrombin, such as oscutarin C from Coastal Taipan venom and ecarin from saw-scaled viper venom, are employed in prothrombin activity assays and lupus anticoagulant detection, and ecarin has a valuable role in quantitative assays of direct thrombin inhibitors. Snake venoms affecting primary hemostasis include botrocetin from the jararaca, which can be used to assay von Willebrand factor activity, and convulxin from the cascavel, which can be used to detect deficiency of the platelet collagen receptor, glycoprotein VI. This article takes the reader to every area of the diagnostic hemostasis laboratory to appreciate the myriad applications of snake venoms available in diagnostic practice.

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Point of care testing to monitor INR control in patients with antiphospholipid syndrome

Masucci

Shingleton

et al. 2022

eJHaem

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Patients with antiphospholipid syndrome (APS) typically require lifelong warfarin anticoagulation following a thrombotic event due to a significant risk of recurrent thrombosis. Point of care testing (POCT) to monitor INR is discouraged in patients with APS as interactions between antiphospholipid antibodies and thromboplastin used for INR testing may influence results. Review of INR testing in 36 APS patients showed 87.2% of paired POCT and venous INRs (n = 94) having acceptable variation (≤0.5 difference), and high correlation (r = 0.9) excluding INRs ≥4.8. Six-month TTR was comparable for APS patients using POCT (57.1% ± 24.8%) to those using venous INR monitoring (59.2% ± 23.2%) (p = 0.66). These results support POCT management of APS but requires further study.

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Monitoring of anticoagulation in thrombotic antiphospholipid syndrome

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 25 publications

References 113 publications

CoaguChek® XS versus standard laboratory prothrombin time for anticoagulant monitoring in patients with antiphospholipid syndrome

CoaguChek® XS versus standard laboratory prothrombin time for anticoagulant monitoring in patients with antiphospholipid syndrome

Snake Venoms in Diagnostic Hemostasis and Thrombosis

Point of care testing to monitor INR control in patients with antiphospholipid syndrome

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