The Russell viper venom time (RVVT) test for investigation of lupus anticoagulant (LA)
Abstract
Lupus anticoagulants (LAs) are a laboratory representation of the clinical syndrome of antiphospholipid syndrome (APS), and can also arise in other pathological states. Laboratory testing for LA is complex and three separate recent guidelines have been published. One test, the Russell viper venom time (RVVT), is the mandated laboratory test for inclusion in LA identification/exclusion in all three guidance documents. This is because the the RVVT is recognized to have great sensitivity for LA, with this generally recognized to be greater than that of most other LA screening assays. However, the RVVT is also very sensitive to the presence of many anticoagulant drugs, which diminishes its specificity for LA. Various strategies can be used to improve LA specificity and reduce anticoagulant assay interference.
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The dRVVT assay is the first recommended test for detecting LA due to its high sensitivity and specificity.
“The diluted Russell’s viper venom time (dRVVT) assay is the first recommended test for detecting LA due to its high sensitivity and specificity [14], while the LA-sensitive activated partial thromboplastin time (aPTT) assay can be used as a secondary test [[11], [12], [13], [14]].”
From Comparison of different algorithms for lupus anticoagulant detection: a single-center experience (2024) · cites this paper as [14]
The LA-sensitive aPTT assay can be used as a secondary test for LA detection.
“The diluted Russell’s viper venom time (dRVVT) assay is the first recommended test for detecting LA due to its high sensitivity and specificity [14], while the LA-sensitive activated partial thromboplastin time (aPTT) assay can be used as a secondary test [[11], [12], [13], [14]].”
From Comparison of different algorithms for lupus anticoagulant detection: a single-center experience (2024) · cites this paper as [14]
Compared with dRVVT, aPTT is a more complex assay involving multiple enzymatic steps and may be influenced by physiologic and pathologic factors unrelated to the inhibition of LA.
“Compared with dRVVT, aPTT is a more complex assay involving multiple enzymatic steps and may be influenced by physiologic and pathologic factors unrelated to the inhibition of LA [14,29].”
From Comparison of different algorithms for lupus anticoagulant detection: a single-center experience (2024) · cites this paper as [14]
Cites
Update of the guidelines for lupus anticoagulant detection
PENGO, V., TRIPODI, A., REBER, G., RAND, J. H., ORTEL, T. L., GALLI, M., & DE GROOT, P. G. (2009) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2009.03555.x · Cited by 1,197 · see citing works
Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity
Siegal, D. M., Curnutte, J. T., Connolly, S. J., Lu, G., Conley, P. B., Wiens, B. L., Mathur, V. S., Castillo, J., Bronson, M. D., Leeds, J. M., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1510991 · Cited by 1,047 · see citing works
Galli, M., Luciani, D., Bertolini, G., & Barbui, T. (2003) · Blood · doi:10.1182/blood-2002-02-0441 · Cited by 974 · cited 1× · see citing works
“This is more so for example than the solid phase antiphospholipid (aPL) antibody assays such as anti-cardiolipin (aCL) and anti-beta2-glyocprotein I (aB2GPI).(1,2,17) However, it should also be recognized that a positive solid phase assay alone (ie, without LA positivity), would still allow a diagnosis of APS in the a…”
BackgroundRecent Guidelines and Recommendations for Laboratory Detection of Lupus Anticoagulants
Moore, G. (2014) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-0033-1364185 · Cited by 148 · cited 19× · see citing works
“Note that LA testing comprises a large part of (acquired) thrombophilia investigations, as patients with LA (APS and other clinical conditions) have an increased risk of thrombosis.1,2 A familiar scenario in the real world is that a patient has a clinically adverse event, such as a thrombosis, and is then quickly star…”
BackgroundMethodInfluentialFavaloro, E., Bonar, R., & Marsden, K. (2012) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-0032-1311993 · Cited by 49 · cited 1× · see citing works
“2 often identifies a cut-off value for LA positivity.(16)”
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Favaloro, E. J. (2020) · American Journal of Hematology · doi:10.1002/ajh.25669 · Cited by 53 · see citing works
Self-citationComparison of different algorithms for lupus anticoagulant detection: a single-center experience
Apipongrat, D., Lamool, R., Arnutti, P., Ruangpratheep, C., & Chantkran, W. (2024) · Research and Practice in Thrombosis and Haemostasis · doi:10.1016/j.rpth.2024.102333 · Cited by 4 · see citing works
- Authors
- Favaloro, E. J.
- Affiliations
- Westmead Hospital (AU)
- Corresponding author
- Favaloro, Emmanuel J.
- Venue
- American Journal of Hematology
- Publisher
- Wiley
- Published
- 2019-08-29
- Volume
- 94
- Issue
- 11
- Pages
- 1290-1296
- ISSN
- 0361-8609 (ISSN-L)
- 1096-8652
- OpenAlex
- W2965497613
- Cited by
- 25
- References
- 5
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 2
- FWCI
- 2.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Hematology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Surgery › Heparin-Induced Thrombocytopenia and Thrombosis
- Keywords
- lupus anticoagulant, antiphospholipid syndrome, assay interference, anticoagulants, assay specificity
- MeSH terms
- Animals, Anticoagulants, Blood Coagulation, False Negative Reactions, False Positive Reactions, Humans, Partial Thromboplastin Time, Prothrombin Time, Sensitivity and Specificity, Viper Venoms, Artifacts, Lupus Coagulation Inhibitor, Practice Guidelines as Topic, Daboia
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