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Cited by 441Systemic Lupus Erythematosus ResearchBlood Coagulation and Thrombosis MechanismsHeparin-Induced Thrombocytopenia and Thrombosis

Guidance from the Scientific and Standardization Committee for lupus anticoagulant/antiphospholipid antibodies of the International Society on Thrombosis and Haemostasis

Open access
Devreese, Katrien M.J., de Groot, Philip G., de Laat, Bas, Erkan, Doruk, Favaloro, Emmanuel J., Mackie, Ian, Martinuzzo, Marta, Ortel, Thomas L. +5 more·2020·Journal of Thrombosis and Haemostasis
DOI 10.1111/jth.15047
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Abstract

This guidance focuses on methodological aspects of lupus anticoagulant (LA) testing, as well as interpretation of results for clinicians. The main changes in how to test for LA compared with the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee 2009 guidelines, in the preanalytical phase are more detailed recommendations on how to handle testing in anticoagulated patients, and the timing of testing. Also, routine coagulation tests are advised to obtain more information on the coagulation background of the patient, and when necessary, anti-Xa activity measurement for heparins or specific assays for direct oral anticoagulants should be performed. The three-step procedure with two test systems (diluted Russell's viper venom time and activated partial thromboplastin time [aPTT]) is essentially not changed. Silica remains the preferable activator in the aPTT assays, but ellagic acid is not excluded. We advise simultaneous performance of the mixing and confirmatory step, in each sample with a prolonged screening test. The confirmatory step can also be performed on a mixture of patient plasma and normal pooled plasma. Cutoff values should be established in-house on at least 120 normals, with transference of the manufacturer's cutoffs as an alternative. Reporting of results has not been changed, although more attention is focused on what clinicians should know. Patient selection for LA testing has been expanded.

AI snapshot

Written from the paper’s full text.

TL;DR

This ISTH-SSC guidance updates recommendations for lupus anticoagulant (LA) testing and interpretation, focusing on preanalytical factors, assay choice, cutoff values, result calculation, and timing. It retains the three-step screen-mix-confirm procedure with dRVVT and aPTT while adding detailed advice for anticoagulated patients, pregnancy, and persistent positivity.

Key findings

  • The three-step procedure with two test systems (dRVVT and aPTT) is essentially unchanged; silica remains the preferable aPTT activator, but ellagic acid is not excluded. The guidance advises simultaneous mixing and confirmatory steps in each sample with a prolonged screening test.
  • Cutoff values should be established in-house on at least 120 normals, with transference of manufacturer’s cutoffs as an alternative; the 99th centile is maintained. In the ISTH-SSC survey, 79% calculated in-house cutoffs but only 12% used >120 normals, and 50% applied the 99th centile.
  • Anticoagulant interference remains a major issue: DOACs give false-positive APTT and dRVVT results even at low concentrations; if DOACs are briefly interrupted, testing can be done at least 48 hours after the last dose, longer in renal impairment, with DOAC levels checked. For LMWH, samples should be taken at least 12 hours after the last dose and anti-Xa activity checked.
  • Repeat testing after an initial positive LA result is still recommended after at least 12 weeks to confirm persistent positivity; triple-positive patients may have predictable persistence, but the guidance concludes retesting after 12 weeks is still recommended.

Methods

  • This is consensus guidance from the ISTH-SSC for lupus anticoagulant/antiphospholipid antibodies, developed after a 2018 ISTH-SSC survey and panel discussion, with invited authors from the 2009 guidelines and other experts.
  • It reviews current literature and focuses on methodology, choice of assays, cutoff values, calculation and interpretation of results, and timing of testing in relation to thrombosis and pregnancy; laboratory aspects in anticoagulated patients are addressed in separate ISTH-SSC guidance.
  • Recommendations are presented in comparison with the ISTH-SSC 2009 guidelines, with a research agenda for unresolved issues.

Limitations

  • The paper states that some points need more evidence before being recommended and provides a research agenda, including optimal timing of initial and subsequent aPL testing, use of lower cutoffs in pregnancy, annual retesting, timing in stroke/TIA, multicenter validation of TSVT/ET, universal cutoff values, and biochemical basis of LA.
  • Evident from the text: this is expert consensus guidance rather than a systematic review or primary validation study, and several recommendations rely on survey practice and literature with acknowledged uncertainty or lack of agreement.
  • Evident from the text: cutoff values determined elsewhere cannot be transferred irrefutably between laboratories because of variables such as sample collection, tubes, normal population demographics, PNP variation, and reagent lots; interlaboratory variability remains a challenge.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/jth.15047

Cites

86 of 86 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

45 of 85 cited sources checked · 20 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Lupus anticoagulant is one of three laboratory criteria used to identify antiphospholipid syndrome.

    “Lupus anticoagulant (LA) is one of the three laboratory criteria for the identification of the antiphospholipid syndrome (APS).1,2”
    Quote in the paperSubstantial claim2 of 2 sources checked
  • Premisecitation

    The 2009 ISTH-SSC guidelines for LA detection have been useful in increasing uniformity in how LA testing is performed and interpreted.

    “The last update of the guidelines for LA detection by the International Society on Thrombosis and Haemostasis Scientific and Standardization Subcommittee (ISTH-SSC) in 2009 12 has proven useful in achieving greater uniformity in performance and interpretation of LA testing.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [12] source

      The Abstract identifies this as the 2009 update and specifies procedures for LA testing and interpretation. Its statement that guidelines had been useful over the preceding 13 years refers to the earlier criteria, not demonstrated effects of the 2009 update. The paper does not establish that the update had already increased uniformity. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    LA is the best-established risk factor for clinical manifestations related to antiphospholipid syndrome.

    “LA is the best-established risk factor for APS-related clinical manifestations.[5][6][7][8][9]”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [5] source
    • cites [6] source
    • cites [7] source

      The Discussion identifies lupus anticoagulant (LAC) as the primary predictor of adverse pregnancy outcome among patients with antiphospholipid antibodies. The study addresses pregnancy outcomes, not APS-related clinical manifestations generally, so it does not establish LA as the best-established risk factor for the broader claim. Page numbers were not provided in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Anticoagulant therapy is a main confounding factor in LA testing because it prolongs clotting times in phospholipid-dependent assays.

    “One of the main confounding factors in LA testing is anticoagulant therapy, prolonging the clotting times in the PL-dependent assays used for LA detection.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [3] source
    • cites [32] source
  • Premisecitation

    In one study, LA results returned to baseline by three months after delivery.

    “LA results returned to baseline status by 3 months postdelivery in one study.23”
    Quote in the paperNot a substantial claim1 of 1 sources checked
  • Classified as probably not a substantial claim. 6
  • May combine two claims. 16

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Sample collection and processing as described in the 2009 ISTH-SSC guidelines is widely applied.

    “Sample collection and processing as described in the ISTH-SSC 2009 guidelines is widely applied.15”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] source

      The Essentials section reports that 86.8% of respondents agreed samples should be collected and processed in line with the 2009 guidelines. That supports broad acceptance of the procedures, but the survey response does not establish that they are widely applied in practice. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    LA detection relies on phospholipid-dependent coagulation tests, which make the methodology and interpretation difficult because anticoagulant therapy and acute phase proteins can interfere.

    “LA detection is based on phospholipid (PL)-dependent coagulation tests, which complicate the methodology and hamper its interpretation because of interference, for instance by anticoagulant therapy and some acute phase response proteins.3,4”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [3] source
    • cites [4] source

      The “Lupus anticoagulant testing” section says LAC detection uses phospholipid-dependent coagulation assays and describes the methodology as complicated. The paper also says anticoagulant therapy can prolong these assays and produce false-positive results. The passages do not establish the claimed interference from acute-phase response proteins. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    British Society for Haematology and Clinical and Laboratory Standards Institute guidelines have also helped increase uniformity.

    “Equally, the British Society for Haematology 13 and the Clinical and Laboratory Standards Institute (CLSI) guidelines 14 have contributed to increased uniformity.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [13] source
    • cites [14]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    LA positivity can fluctuate over time, with or without systemic lupus erythematosus, and during pregnancy it may decrease or increase.

    “LA positivity may fluctuate over time with or without the presence of systemic lupus erythematosus 22,23 and during pregnancy, either decreasing or increasing.22,24,25”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [22] source

      The Introduction (page not provided), under “Limitations to current classification criteria for APS,” says antiphospholipid antibodies can fluctuate in patients with or without SLE, supporting the general fluctuation claim. It does not say that lupus anticoagulant specifically decreases or increases during pregnancy; its pregnancy discussion concerns adverse outcomes, not changes in positivity. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [23] source

      The Results section (page unavailable) reports that LAC positivity declined during pregnancy among women positive at screening, while 18% of those negative at screening became positive by the second trimester. The study included women with and without SLE, but reports these changes for the group overall; it does not establish that LAC positivity fluctuates in each SLE subgroup or outside pregnancy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [24] source

      The Results and Discussion report changing anti-cardiolipin and anti-β2-glycoprotein antibody levels during healthy pregnancy, including increases in IgG and a transient decrease in IgM. They do not establish that lupus anticoagulant (LA) positivity fluctuates, either during pregnancy or in people with or without systemic lupus erythematosus. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [25] source

  • May combine two claims.

    Findingcitation

    Survey responses showed uncertainty or lack of agreement on testing in anticoagulated patients, cutoff values, and calculation and interpretation of results.

    “However, on other points, including testing in patients on anticoagulation, cutoff values, and calculation and interpretation of results, there was uncertainty or lack of agreement.12,15”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [12] source

      The Patient selection section (page unavailable) reports variability in laboratory performance and says cut-off values and expression of results affect LA testing. The Integrated tests section (page unavailable) says interpreting results in patients taking vitamin K antagonists is difficult. These passages support difficulties with the named testing issues, but the paper does not report survey responses showing uncertainty or lack of agreement on them. (LLM, conf=0.77)

      Experimental — accuracy not yet measured
    • cites [15] source

  • May combine two claims.

    Premisecitation

    Unfractionated heparin and enoxaparin affect dRVVT at supra-therapeutic anti-Xa levels but did not cause false-positive LA in the three-step procedure.

    “a recent study 33 showed unfractionated heparin (UFH) and enoxaparin affect the dRVVT at supra-therapeutic anti-Xa levels but did not lead to false-positive LA in the three step procedure.”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Clotting times or ratios in LA testing are not normally distributed, which supports determining cutoff values by a nonparametric centile method.

    “A recent study showed that clotting times or ratios in LA testing were not normally distributed, which confirms that cutoff values should be determined by a nonparametric method based on centiles.73”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Restricting the choice of assays reduces interlaboratory and interassay variability and the number of false positives.

    “a restriction in the choice of assays reduces the interlaboratory and interassay variability, as well as the number of false positives.2”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [2] source

      The ‘Anticardiolipin and beta2-glycoprotein I antibodies’ section (page unavailable) says harmonized protocols on automated platforms may reduce interlaboratory variation. The ‘Antibody profiles’ section (page unavailable) also notes interassay variability, but the paper does not say that restricting assay choice reduces either form of variability or the number of false positives. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    The ISTH-SSC survey showed considerable lack of agreement on cutoff calculation: 79% calculated in-house cutoffs, but only 12% used more than 120 normal samples.

    “The ISTH-SSC survey showed a considerable lack of agreement on calculation of cutoff values, although 79% stated that they calculate their in-house cutoff values, but only 12% indicated use of >120 normals.15”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] source

      The 'Number of healthy adult donors for the preparation of in-house' section reports that 78.9% of laboratories calculated in-house cutoffs, and the discussion reports considerable disagreement about cutoffs. The 12% figure applies only to respondents who indicated use of the 99th centile, not to respondents overall; Figure 4B shows 4% selecting >120 donors in its broader question. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Pretreatment with adsorbents may alter clotting times, producing false-positive or false-negative LA results or incomplete removal of direct oral anticoagulants.

    “Several studies indicated that pretreatment with adsorbents may affect clotting times resulting in false-positive or false-negative LA results, or incomplete removal of DOACs.33,[41][42][43]”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [33] source

      The Results and Discussion report that activated-carbon pretreatment prolonged APTT screening clotting times, and the Conclusions warn that three-step testing is needed to avoid potential misdiagnosis. But the study found that pretreatment did not alter its final LA interpretations; it does not report false-negative LA results or incomplete DOAC removal. Its false-positive LA findings concerned high levels of enoxaparin and danaparoid, not adsorbent pretreatment. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [41] source
    • cites [42] source

      The DOAC-Stop® Treatment section (page unavailable) says the adsorbent minimally affected aPTT and PT in samples without DOACs. It does not show adsorbent-induced false-positive or false-negative LA results: the Results report that false-positive LA results fell to zero after treatment and residual DOAC levels were below assay quantification limits. The Discussion notes that LA-positive patients were not included, limiting what the study can say about false negatives. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Most survey participants indicated that pooled normal plasma should be constituted from at least 40 donors.

    “The majority of survey participants indicated that the number should be at least 40, which seems reasonable to guarantee an overall normal clotting factor activity. 12”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] source

      The Mixing test section says pooled normal plasma should have approximately 100% activity for all clotting factors, but gives no donor count or survey response. The Integrated tests section specifies at least 40 healthy donors for establishing local test cut-offs, not for constituting pooled normal plasma. A search for the survey majority and the proposed PNP donor count found no passage addressing either point; page numbers were unavailable in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    A study of three commercial LA platforms following ISTH-SSC guidelines found platform-to-platform differences in clotting times and ratios, and differences among participants using the same platform, even after outlier exclusion.

    “Differences were observed between platforms for clotting times as well as results expressed as ratio, but also between participants using the same platform.These differences were observed even after detection and exclusion of outliers before cutoff calculation.74”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [73] source

      The Results and Cut-off values sections describe three commercial platforms and differences in cut-off values between platforms and between laboratories using the same platform, for both clotting times and ratios. But the LA-negative plasma section explicitly says the authors analyzed all results without detecting or rejecting outliers. The claim that the differences persisted after outlier exclusion is therefore not supported by this study. (LLM, conf=0.92)

      Experimental — accuracy not yet measured
    • cites [74] source

  • May combine two claims.

    Premisecitation

    The Sydney criteria's 12-week interval rests on expert opinion, and knowledge about aPL persistence past 3 months is limited.

    “The interval of 12 weeks, defined in the Sydney criteria (previously 6 weeks in the Sapporo criteria), was based on expert opinion and little is known on persistence of aPL beyond 3 months.1”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [1] source

      The Update of the classification criteria section says the Sapporo interval was 6 weeks, proposes 12 weeks, and explicitly states that the proposed time intervals are based on expert opinion. It calls for studies validating those intervals and describes relevant data as poor, but does not specifically say that little is known about aPL persistence beyond 3 months. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Fifty-one percent of survey participants indicated that plasma should ideally be frozen within four hours.

    “A total of 51% of the participants of the survey indicated plasma should ideally be frozen within 4 hours, in accordance with general guidelines for coagulation assays.27”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Freeze-thawing can increase diluted Russell's viper venom time ratios and lead to false-negative LA results.

    “The effect of freeze-thawing on diluted Russell's viper venom time (dRVVT) ratios leading to false-negative results was confirmed in a more recent study.28”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] source

  • May combine two claims.

    Interpretationreasoning

    A negative or positive LA result during pregnancy does not by itself exclude or confirm antiphospholipid syndrome.

    “negative or positive LA (or anticardiolipin [aCL]/ anti-β2glycoprotein I [aβ2GPI]) during pregnancy does not exclude or confirm a diagnosis of APS.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The authors of the multicenter study recommended identifying outliers before cutoff calculation using one of the available algorithms.

    “This notwithstanding, the authors recommended the identification of outliers before cutoff calculation by using one of the current available algorithms.74”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] source

  • May combine two claims.

    Premiseown data

    Outlier elimination did not appreciably affect inter-laboratory variability of LA cutoff values, indicating that outliers are not the main cause of that variability.

    “Based on the same data of this multicenter study, it was illustrated that variable numbers of outliers were identified depending on the algorithm used for identification and that their elimination showed no appreciable effects on the inter-laboratory variability of cutoff values, indicating that outliers are not the main cause of the inter-laboratory variability of cutoffs for LA detection.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Since most triple-positive patients remain triple positive, their confirmation appears predictable without a 12-week retest.

    “Confirmation of triple-positive patients (same isotype 81 or independent of isotype of aCL and aβ2GPI 80 ) seems to be predictable without the need to retest after 12 weeks because triplepositivity persists in the majority of patients.80,81”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [80] source
    • cites [81] source

  • Classified as probably not a substantial claim.

    Interpretationcitation

    These findings favor lengthening the retest interval past 12 weeks so that patients still positive after that point can be identified.

    “These results support the choice of extending the retest interval beyond 12 weeks, which would identify patients who remain persistently positive even beyond this period.80”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [80] source

  • May combine two claims.

    Premisecitation

    A retrospective study found extended aPL persistence in 96% of patients over a median 56-week follow-up, with single-positive patients not significantly less persistent than double- or triple-positive patients.

    “A retrospective study evaluated extended persistence and demonstrated persistence in 96% in a median follow-up of 56 weeks, with no significant lower persistence in the single positive patients compared with the double and triple positives.80”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [80] source

  • May combine two claims.

    Premisecitation

    Reagent lot variation is a probable explanation for the differences, supported by a multicenter study in which every center used one common lot.

    “Probably, they might be explained by the variation in reagent lots, as confirmed in another multicenter study with the same reagent lot used by all participating centers.77”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [77] source
22 of 22

  • The paper relies on this without support.

    The survey respondents are representative of the spectrum of clinical and laboratory practice in LA detection.

    “The responses forced the formulation of further ISTH-SSC recommendations.”

  • The authors state this as an assumption.

    Manufacturers' cutoffs are established by appropriate statistical models using a sufficiently large donor population.

    “However, this assumes that manufacturers' cutoffs are established by appropriate statistical models using a sufficiently large donor population.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • ISTH SSC 2020 guideline recommends performing the mixing and confirmatory tests simultaneously if the screening test shows the presence of LA.

    “In contrast, the ISTH SSC 2020 guideline recommends performing the mixing and confirmatory tests simultaneously if the screening test shows the presence of LA [20].”

    From Comparison of different algorithms for lupus anticoagulant detection: a single-center experience (2024) · cites this paper as [20]

    Section 3.4, “Three step procedure” (page not provided), says that performing the mixing and confirmatory steps at the same time after a suggestive screening test can be helpful. It does not explicitly recommend simultaneous testing, so the claim states the guidance more strongly than the source does. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • PNP should be platelet-free, its content of each coagulation factor should be close to 100%, and it should be obtained from at least 20-40 healthy donors.

    “PNP is very important for the standardization of the mixing test; it should be platelet-free, its content of each coagulation factor should be close to 100%, and it should be obtained from at least 20–40 healthy donors (males and females) [9,48].”

    From Lupus Anticoagulant Detection under the Magnifying Glass (2023) · cites this paper as [9]

    Section 3.4 (page not available) specifies minimal residual platelets and approximately 100% (>80%) clotting-factor activity for PNP. It says the donor minimum is difficult to define but treats at least 40 as reasonable; it does not support a minimum as low as 20 or specify male and female donors. “Platelet-free” is also stronger than its wording. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Current guidelines recommend avoiding LA testing during an acute thrombotic event or an acute episode (e.g., an infection).

    “Current guidelines recommend avoiding LA testing during an acute thrombotic event or an acute episode (e.g., an infection) [9]”

    From Lupus Anticoagulant Detection under the Magnifying Glass (2023) · cites this paper as [9]

    Section 2.2 (page unavailable) says LA results obtained during the acute phase, including soon after a thrombotic event, should be interpreted with caution because of possible test interference. It does not recommend avoiding testing altogether; it says acute-phase testing may be needed. Section 4 (page unavailable) notes that infection can cause transient LA positivity and recommends confirming a positive result after 12 weeks, not avoiding testing during infection. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Clotting times of screening, mixing, and confirmatory procedures are prone to inter- and intra-assay variability; therefore, it is recommended to normalize these clotting times by generating a ratio between test clotting time and NPP clotting time.

    “Clotting times of screening, mixing, and confirmatory procedures are prone to inter- (between same-principle tests offered by different manufacturers) and intra-assay (between batches of the same reagent) variability [25]; for this reason, it is recommended to normalize a screening, mixing, and confirmatory clotting time, generating a ratio between test clotting time and NPP clotting time [9,36,48”

    From Lupus Anticoagulant Detection under the Magnifying Glass (2023) · cites this paper as [9]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • ISTH guidelines expressly recommend not using cut-off values established elsewhere, but using "in house" cut-off values deriving from a sufficiently large population of healthy individuals (at least 120), with the cut-off determined as the 99th percentile.

    “ISTH guidelines expressly recommend not using cut-off values established elsewhere, but using “in house” cut-off values deriving from a sufficiently large population of healthy individuals (at least 120): the value of cut-off is determined to be the 99th percentile [9].”

    From Lupus Anticoagulant Detection under the Magnifying Glass (2023) · cites this paper as [9]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

Cites

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Related

Authors
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., Tripodi, A., Wahl, D., & Cohen, H.
Affiliations
  • Ghent University Hospital (BE)
  • Hospital for Special Surgery (US)
  • Westmead Hospital (AU)
  • University College London (GB)
  • Hospital Italiano de Buenos Aires (AR)
  • Duke Medical Center (US)
  • University of Padua (IT)
  • Cornell University (US)
  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
  • Inserm (FR)
  • University College Hospital (GB)
Corresponding author
Devreese, Katrien M.J.
ORCID
Venue
Journal of Thrombosis and Haemostasis
Publisher
Elsevier BV
Published
2020-11
Volume
18
Issue
11
Pages
2828-2839
ISSN
1538-7836 (ISSN-L)
DOI
10.1111/jth.15047
OpenAlex
W3096784218
Cited by
439
References
88
Citations by year
2026: 71 · 2025: 75 · 2024: 97 · 2023: 95 · 2022: 55 · 2021: 42 · 2020: 4
FWCI
31.22
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Thrombosis and Haemostasis (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
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 antibodies, pre-analytical phase, anticoagulated patients, coagulation tests, anti-Xa activity, direct oral anticoagulants, activated partial thromboplastin time
MeSH terms
Blood Coagulation Tests, Humans, Partial Thromboplastin Time, Prothrombin Time, Reference Standards, Thrombosis, Lupus Coagulation Inhibitor, Antiphospholipid Syndrome

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

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