Rivaroxaban Therapy, False-Positive Lupus Anticoagulant Screening Results, and Confirmatory Assay Results: Table 1.

Murer, Lauren M.; Pirruccello, Samuel J.; Koepsell, Scott A.

doi:10.1093/labmed/lmw029

Cited by 8 publications

(7 citation statements)

References 12 publications

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“…The obtained data showed a clear correlation between plasma levels of rivaroxaban and the dRVVT ratio. This observation is in line with previous studies in smaller populations or in vitro analyses, in which an interference of rivaroxaban on functional LA testing has been shown 14 – 17 , 19 , 21 , 25 – 27 . Considering the calculated correlation coefficients rivaroxaban had the greatest impact on dRVVT results of all anticoagulant drugs evaluated in our study.…”

Section: Discussionsupporting

confidence: 92%

Functional lupus anticoagulant testing in a large retrospective cohort of thrombosis patients with direct oral anticoagulants

Reda

Brügelmann

Müller

et al. 2020

Sci Rep

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functional tests for lupus anticoagulants (LA) as part of a thrombophilia workup are commonly performed in patients under anticoagulant therapy that may interfere with assay results. there is no consensus on how these tests should be assessed in patients on direct oral anticoagulants (DoAcs). in this retrospective cohort study, we analysed data from patients with a history of thrombosis in whom dilute Russell viper venom time (dRVVt), LA-sensitive aptt, and solid phase assays for antiphospholipid antibodies (aPL) were performed (n = 3,147, thereof 588 on rivaroxaban, 144 on apixaban, 1,179 on other anticoagulant drugs). The dRVVT ratio was correlated with rivaroxaban (r = 0.30, P < 10-4) but not with apixaban plasma levels. The LA-sensitive aPTT/aPTT ratio showed no correlation with DoAc levels. correspondingly, the rate of patients with abnormal dRVVt test was significantly higher (P < 10-4) under rivaroxaban (88%) than in thrombosis patients without anticoagulant medication (6%), independent from their aPL plasma levels. No isolated positive results of functional LA testing in patients on anticoagulants could be confirmed in repeated testing after discontinuation of the medication (n = 40). These data indicate that rivaroxaban should be discontinued before functional LA testing is performed. However, viable interpretation of these tests appears to be less affected in patients on apixaban.

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Section: Discussionsupporting

confidence: 92%

Functional lupus anticoagulant testing in a large retrospective cohort of thrombosis patients with direct oral anticoagulants

Reda

Brügelmann

Müller

et al. 2020

Sci Rep

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show abstract

“…The potential problems with testing for LA in patients on DOAC therapy have been illustrated in many reports 13‐34 . The main issue is that DOACs may cause false‐positive LA results, but the effects seem to be dependent on both the type of DOAC and the LA reagent, making it difficult to compare results from published studies.…”

Section: Discussionmentioning

confidence: 99%

“…As the dRVVT test is dependent on both factor Xa and thrombin, the test may be influenced by all DOACs in a dose‐dependent manner. Indeed, there are now several interesting reports on DOAC interferences on different LA tests that warrant a cautious interpretation of the results when DOACs are present 13‐34 . The reports mainly emphasize the risk of false‐positive LA test results during DOAC therapy (although the effects vary with the type of DOAC and the type of dRVVT reagent), indicating that a local validation of the test system might be necessary to avoid diagnostic problems.…”

Section: Introductionmentioning

confidence: 99%

Unveiling the complex effects of direct oral anticoagulants on dilute Russell's viper venom time assays

Hillarp

Strandberg

Gustafsson

et al. 2020

Journal of Thrombosis and Haemostasis

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“…While it would be reasonable to monitor our patient for signs of SLE in the future, this would remain a very unlikely development. False positive antiphospholipid antibody results have been described in patients who have received rivaroxaban within 24 hours and possibly up to several days [59–61]. To the best of our knowledge, however, our patient last received rivaroxaban several weeks prior to the antiphospholipid assay, so we consider this an unlikely explanation.…”

Section: Discussionmentioning

confidence: 73%

Ménétrier’s disease presenting as recurrent unprovoked venous thrombosis: a case report

Greenblatt

Nguyen

2019

J Med Case Reports

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BackgroundAcquired thrombophilia is a potential sequela of malignancy, chronic inflammation, and conditions characterized by severe protein deficiency (for example, nephrotic syndrome, protein-losing enteropathy). As such, venous thrombosis is often a feature, and occasionally a presenting sign, of systemic disease. Ménétrier’s disease is a rare hyperplastic gastropathy that may lead to gastrointestinal protein loss and hypoalbuminemia. To date, reports of venous thrombosis associated with Ménétrier’s disease are exceedingly scarce.Case presentationWe report the case of a 40-year-old white man who presented with unprovoked deep venous thrombosis, pulmonary embolism, and renal vein thrombosis. Upon receiving therapeutic anticoagulation, he developed severe gastrointestinal bleeding, and endoscopic evaluation led to a diagnosis of Ménétrier’s disease. A laboratory workup revealed deficiency of protein C, protein S, and antithrombin III, as well as markedly elevated levels of factor VIII. He was determined to have an acquired thrombophilia as a direct result of Ménétrier’s disease.ConclusionsThis case describes an acquired thrombophilic state in a patient with Ménétrier’s disease and profound hypoalbuminemia. Although this association is rarely described, we discuss the probable mechanisms leading to our patient’s thrombosis. Specifically, we posit that his gastrointestinal protein loss led to a deficiency of several anticoagulant proteins and a compensatory elevation in factor VIII, as occurs in nephrotic syndrome and inflammatory bowel disease. Of note, this patient’s recurrent venous thrombosis was the initial clinical sign of his gastrointestinal pathology.

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Rivaroxaban Therapy, False-Positive Lupus Anticoagulant Screening Results, and Confirmatory Assay Results: Table 1.

Cited by 8 publications

References 12 publications

Functional lupus anticoagulant testing in a large retrospective cohort of thrombosis patients with direct oral anticoagulants

Functional lupus anticoagulant testing in a large retrospective cohort of thrombosis patients with direct oral anticoagulants

Unveiling the complex effects of direct oral anticoagulants on dilute Russell's viper venom time assays

Ménétrier’s disease presenting as recurrent unprovoked venous thrombosis: a case report

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