Current Controversies in Lupus Anticoagulant Detection
Open accessAbstract
Antiphospholipid syndrome is an autoimmune, acquired thrombophilia diagnosed when vascular thrombosis or pregnancy morbidity are accompanied by persistent antiphospholipid antibodies. Lupus anticoagulants (LA) are one of the criteria antibodies but calibration plasmas are unavailable and they are detected by inference based on antibody behaviour in a medley of coagulation-based assays. Elevated screening tests suggest the presence of a LA, which is confirmed with mixing tests to evidence inhibition and confirmatory tests to demonstrate phospholipid-dependence. At least two screening tests of different principle must be used to account for antibody heterogeneity and controversy exists on whether assays, in addition to dilute Russell's viper venom time and activated partial thromboplastin time, should be employed. A variety of approaches to raw data manipulation and interpretation attract debate, as does inclusion or exclusion of mixing studies in circumstances where the presence of a LA is already evident from other results. Therapeutic anticoagulation compromises coagulation-based assays but careful data interpretation and use of alternative reagents can detect or exclude LA in specific circumstances, and this aspect of LA detection continues to evolve. This review focuses on the main areas of debate in LA detection.
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There is currently no established gold standard assay or reference plasma for LA detection.
“As a result, there are currently no established gold standard assays or reference plasmas for LA detection [[6], [7], [8], [9], [10]].”
From Comparison of different algorithms for lupus anticoagulant detection: a single-center experience (2024) · cites this paper as [9]
Technical and practical issues, including test algorithms, interpretation parameters, cutoff values, and methods of interpretation, are problematic in many laboratories.
“Technical and practical issues, including test algorithms, interpretation parameters, cutoff values, and methods of interpretation, are problematic in many laboratories [6,8,9,21].”
From Comparison of different algorithms for lupus anticoagulant detection: a single-center experience (2024) · cites this paper as [9]
In theory, coagulation factors contained in PNP will correct the prolongation of the screening test if affected by a deficiency of one or more factors; if an inhibitor is present, the clotting time will remain prolonged.
“In theory, the coagulation factors contained in PNP will correct the prolongation of the screening test, restoring a clotting time that falls in the range of normality, if affected by a deficiency of one (or more) factors; if an inhibitor is present, the clotting time will remain prolonged [46,47].”
From Lupus Anticoagulant Detection under the Magnifying Glass (2023) · cites this paper as [47]
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Evaluation of a modified procedure for Staclot LA for the confirmation of lupus anticoagulants.
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Standardization of lupus anticoagulant. The Lupus Anticoagulant Sensitivity Index (LASI)
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Arachchillage, D. J., Gomez, K., Alikhan, R., Anderson, J. A. M., Lester, W., Laffan, M., & British Society for Haematology Haemostasis and Thrombosis Taskforce (2020) · British Journal of Haematology · doi:10.1111/bjh.16308 · Cited by 88 · see citing works
Moore, G. W., Jones, P. O., Platton, S., Hussain, N., White, D., Thomas, W., Rigano, J., Pouplard, C., Gray, E., & Devreese, K. M. J. (2021) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.15438 · Cited by 47 · see citing works
Self-citationCurrent Promising Biomarkers and Methods in the Diagnostics of Antiphospholipid Syndrome: A Review
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Testing for Lupus Anticoagulants
Moore, G. W. (2022) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-0042-1744363 · Cited by 30 · see citing works
Self-citationMixing studies for lupus anticoagulant: mostly no, sometimes yes
Moore, G. W. (2020) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2019-1248 · Cited by 19 · see citing works
Self-citationThrombophilia testing in the era of direct oral anticoagulants
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Evaluation of Activated Partial Thromboplastin Time Mixing Studies Using Several Methods
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Lupus Anticoagulant Detection under the Magnifying Glass
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“In theory, the coagulation factors contained in PNP will correct the prolongation of the screening test, restoring a clotting time that falls in the range of normality, if affected by a deficiency of one (or more) factors; if an inhibitor is present, the clotting time will remain prolonged [46,47].”
BackgroundUpdate on the Diagnosis and Anticoagulant Treatment of the Antiphospholipid Syndrome
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Analytical dilemmas in lupus anticoagulant detection
Moore, G. W. (2023) · Exploration of Immunology · doi:10.37349/ei.2023.00104 · Cited by 5 · see citing works
Self-citationViewpoint: Lupus anticoagulant detection and interpretation in antiphospholipid syndrome
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Comparison 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
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Homozygous Factor V Leiden Complicated by Heparin-Induced Thrombocytopenia: A Case Report
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Quantitative Risk for Single-Positive Lupus Anticoagulant Results With Different Anticoagulants
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Extensive Workup on Early-Onset Fibromyalgia: A Case Report
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To do or not to do mixing study in the era of integrated testing for lupus anticoagulant
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- Authors
- Moore, G.
- Affiliations
- St Thomas' Hospital (GB)
- Corresponding author
- Moore, Gary
- ORCID
- Moore, Gary
- Venue
- Antibodies
- Publisher
- MDPI AG
- Published
- 2016-12-02
- Volume
- 5
- Issue
- 4
- Pages
- 22
- ISSN
- 2073-4468 (ISSN-L)
- PMC
- PMC6698846
- OpenAlex
- W2558208612
- Cited by
- 36
- References
- 101
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 4 · 2022: 8 · 2021: 7 · 2020: 1 · 2019: 4 · 2018: 2 · 2017: 3
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Antibodies (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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, antiphospholipid antibodies, acquired thrombophilia, coagulation tests, dilute Russell's viper venom time, activated partial thromboplastin time, mixing studies, screening test, therapeutic anticoagulation, assay interpretation, antibody heterogeneity
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