Laboratory Diagnosis of Lupus Anticoagulants for Patients on Oral Anticoagulant Treatment

Armando Tripodi; Veena Chantarangkul; Marigrazia Clerici; Pier Mannuccio Mannucci

doi:10.1055/s-0037-1613259

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2002; 88(04): 583-586
DOI: 10.1055/s-0037-1613259

Review Article

Schattauer GmbH

Laboratory Diagnosis of Lupus Anticoagulants for Patients on Oral Anticoagulant Treatment

Performance of Dilute Russell Viper Venom Test and Silica Clotting Time in Comparison with Staclot^® LA

Armando Tripodi

¹Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine, University and IRCCS Maggiore Hospital, Milano, Italy

,

Veena Chantarangkul

¹Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine, University and IRCCS Maggiore Hospital, Milano, Italy

,

Marigrazia Clerici

¹Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine, University and IRCCS Maggiore Hospital, Milano, Italy

,

Pier Mannuccio Mannucci

¹Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine, University and IRCCS Maggiore Hospital, Milano, Italy

› Author Affiliations

Abstract

Summary

The detection of lupus anticoagulant (LA) in plasmas from patients on oral anticoagulants is problematic because of their prolonged clotting times. Mixing of patients and normal plasmas prior to testing for LA is employed to overcome this problem. We investigated the diagnostic efficacy of silica clotting time (SCT) and dilute Russell viper venom test (dRVVT) performed at low and high phospholipid concentrations, to diagnose LA in patients on oral anticoagulants, in comparison with Staclot^® LA (Stago) performed with and without hexagonal phospholipids and normal plasma. Case materials were 114 filtered plasmas from patients on oral anticoagulants with (n = 62) and without (n = 52) the antiphospholipid syndrome. Plasmas were considered LA-positive when Staclot^® LA (taken as the “gold standard”) was diagnostic for LA. Forty-four plasmas were positive with Staclot^® LA. Forty and 39 of these were also positive with SCT and dRVVT (sensitivity relative to Staclot^® LA was 91% and 89%, respectively). Seventy plasmas were negative with Staclot^® LA. Three of these were positive with both SCT and dRVVT (specificity relative to Staclot^® LA was 96%). Kappa values for measure of agreement were 0.87 and 0.85 (p <0.001), respectively. In conclusion, SCT and dRVVT performed at low and high phospholipid concentrations without normal plasma can be considered as reliable as Staclot^® LA peformed with hexagonal phospholipids and normal plasma to diagnose LA in patients on oral anticoagulants. Advantages of SCT and dRVVT over Staclot^® LA are easy automation, no need for normal plasma and relatively low cost.

Keywords

Lupus anticoagulant - oral anticoagulation - thrombosis

Full Text

References

References
1 Triplett DA. Antiphospholipid-protein antibodies: laboratory detection and clinical relevance. Thromb Res 1995; 78: 1-31.
2 Arnout J. Antiphospholipid antibody syndrome: Diagnostic aspects of Lupus Anticoagulants. Thromb Haemost 2001; 86: 75-82.
3 Bowie EJW, Thompson Jr JH, Pascuzzi GA, Owen Jr CA. Thrombosis in systemic lupus erythematosus despite circulating anticoagulants. J Lab Clin Med 1963; 62: 416-30.
4 Wahl DG, Guillemin F, de Maistre E, Perret C, Lecompte T, Thibaut G. Risk for venous thrombosis related to antiphospholipid antibodies in systemic lupus erythematosus. A meta-analysis. Lupus 1997; 06: 467-73.
5 Wahl DG, Guillemin F, de Maistre E, Perret-Guillaume C, Lecompte T, Thibaut G. Meta-analysis of the risk of venous thrombosis in individuals with antiphospholipid antibodies without underlying autoimmune disease or previous thrombosis. Lupus 1998; 07: 15-22.
6 Rai RS, Regan L, Clifford K, Pickering W, Dave M, Mackie I, McNally T, Cohen H. Antiphospholipid antibodies and beta2-glycoprotein I in 500 women with recurrent miscarriage: results of a comprehensive screening approach. Human Reproduction 1995; 10: 2001-5.
7 Tripodi A, Mannucci PM. Laboratory investigation of thrombophilia. Clin Chem 2001; 47: 1597-606.
8 Greaves M, Cohen H, Machin SJ, Mackie I. Guidelines on the investigation and management of the antiphospholipid syndrome. Brit J Haematol 2000; 109: 704-15.
9 Brandt JT, Triplett DA, Alving B, Scharrer I. Criteria for the diagnosis of lupus anticoagulants: an update. Thromb Haemost 1995; 74: 1185-90.
10 Rauch J, Tannenbaum M, Janoff AS. Distinguishing plasma lupus anticoagulants from anti-factor antibodies using hexagonal (II) phase phospholipids. Thromb Haemost 1989; 62: 892-6.
11 Triplett DA, Barna LK, Unger GA. A hexagonal (II) phase phospholipid neutralization assay for lupus anticoagulant identification. Thromb Haemost 1993; 70: 787-93.
12 Hirsh J, Dalen JE, Anderson DR, Poller L, Bussey H, Ansell J, Deykin D. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 2001; 119: 8S-21S.
13 Chantarangkul V, Tripodi A, Arbini A, Mannucci PM. Silica clotting time (SCT) as a screening and confirmatory test for detection of the lupus anticoagulants. Thromb Res 1992; 67: 355-65.
14 Lawrie AS, Purdy G, Mackie IJ, Machin SJ. Monitoring of oral anticoagulant therapy in lupus anticoagulant positive patients with the anti-phospholipid syndrome. Br J Haematol 1997; 98: 887-92.
15 Triplett DA, Stocker KF, Unger GA, Barna LK. The textarin/ecarin ratio. A confirmatory test for lupus anticoagulants. Thromb Haemost 1993; 70: 925-31.
16 Rooney AM, McNally T, Mackie IJ, Machin SJ. The Taipan snake venom time; a new test for lupus anticoagulant. J Clin Pathol 1994; 47: 497-501.
17 Chantarangkul V, Crippa L, Tripodi A, Mannucci PM. Colloidal silica clotting time (CSCT) in the detection of lupus anticoagulant. Thromb Res. 1991 Suppl XIII: 79.
18 Tripodi A, Chantarangkul V, Clerici M, Negri B, Galli M, Mannucci PM. Laboratory control of oral anticoagulant treatment by the INR system in patients with the antiphospholipid syndrome and lupus anticoagulant. Results of a collaborative study involving nine commercial reagents. Brit J Haematol 2001; 115: 672-8.
19 Jennings I, Kitchen S, Woods TA, Preston FE, Greaves M. Potentially clinically important inaccuracies in testing for lupus anticoagulant: an analysis of results from three surveys of the UK National External Quality Assessment Scheme (NEQAS) for blood coagulation. Thromb Haemost 1997; 77: 934-7.
20 Galli M, Finazzi G, Norbis F, Marziali S, Marchioli R, Barbui T. The risk of thrombosis in patients with lupus anticoagulants is predicted by their specific coagulation profile. Thromb Haemost 1999; 81: 695-700.