Variable Performance of Lupus Anticoagulant Testing: The Australasian/Asia-Pacific Experience
Abstract
Lupus anticoagulant (LA) is one of three tests identified as laboratory criteria for definite antiphospholipid syndrome (APS). The other two tests are anticardiolipin antibody (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibody. The presence of LA is assessed using clot-based tests, while the presence of aCL and aβ2GPI is assessed by immunological assays. Since no test can be considered 100% sensitive or specific for LA, current guidelines recommend using two different clot-based assays reflecting different principles, with the dilute Russell viper venom time (dRVVT) and activated partial thromboplastin time (aPTT) recommended. Initially, LA-sensitive reagents are used to screen for LA, and then, in "screen-positive" samples, LA-"insensitive" reagents are used to confirm LA. Because LA assays are based on clot detection, anything that can interfere with fibrin clot development may affect test results. In particular, in addition to LA, the tests are also sensitive to the presence of a wide range of clinical anticoagulants, reflecting preanalytical issues for testing. We provide updated findings for LA testing in our geographic region, using recent data from the Royal College of Pathologists of Australasia Quality Assurance Programs, an international external quality assessment program with approximately 120 participants. Data show a wide variety of assays in use, especially for aPTT testing, and variable outcomes in reported numerical values with these assays when assessing pro…
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The aPTT reagent pair used in this study (Actin FSL for screening and Actin FS for confirmation) is one of only a few paired aPTT reagents offered by commercial manufacturers, with most manufacturers of silica-based aPTT assays offering an LA-sensitive reagent, but not providing an LA insensitive silica-based paired reagent.
“On the other hand, the aPTT reagent pair used in this study (Actin FSL for screening and Actin FS for confirmation) is one of only a few paired aPTT reagents offered by commercial manufacturers, with most manufacturers of silica-based aPTT assays offering an LA-sensitive reagent, but not providing an LA insensitive silica-based paired reagent [32].”
From Comparison of different algorithms for lupus anticoagulant detection: a single-center experience (2024) · cites this paper as [32]
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
Devreese, K. M. J., de Groot, P. G., de Laat, B., Erkan, D., Favaloro, E. J., Mackie, I., Martinuzzo, M., Ortel, T. L., Pengo, V., Rand, J. H., et al. (2020) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.15047 · Cited by 439 · see citing works
Self-citationTripodi, A., Cohen, H., & Devreese, K. M. J. (2020) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.14846 · Cited by 143 · see citing works
Favaloro, 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
“10 As already noted, some contemporary fi ndings replicate those we reported at that time, including the “ generic ” or “ default ” cut off of 1.2 for dRVVT screen/con fi rm to identify LA positivity.”
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Devreese, K. M. J., Bertolaccini, M. L., Branch, D. W., de Laat, B., Erkan, D., Favaloro, E. J., Pengo, V., Ortel, T. L., Wahl, D., & Cohen, H. (2025) · Journal of Thrombosis and Haemostasis · doi:10.1016/j.jtha.2024.10.022 · Cited by 92 · 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
Lupus Anticoagulant Testing in Challenging Situations: Navigating Complexities
Devreese, K. M. J. (2026) · International Journal of Laboratory Hematology · doi:10.1111/ijlh.14490 · Cited by 2 · see citing works
- Authors
- Favaloro, E. J., Dean, E., & Arunachalam, S.
- Affiliations
- The University of Sydney (AU)
- Royal College of Pathologists of Australasia (AU)
- Corresponding author
- Favaloro, Emmanuel J.
- Venue
- Seminars in Thrombosis and Hemostasis
- Publisher
- Georg Thieme Verlag KG
- Published
- 2023-11-15
- Volume
- 50
- Issue
- 08
- Pages
- 1103-1113
- ISSN
- 0094-6176 (ISSN-L)
- 1098-9064
- OpenAlex
- W4388714363
- Cited by
- 11
- References
- 4
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 7
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Seminars in Thrombosis and Hemostasis (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- lupus anticoagulant, antiphospholipid syndrome, dilute Russell viper venom time, activated partial thromboplastin time, assay variability, external quality assessment, anticoagulants
- MeSH terms
- Blood Coagulation Tests, Female, Humans, Partial Thromboplastin Time, Lupus Coagulation Inhibitor, Antiphospholipid Syndrome, Australasia
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