Applying index of circulating anticoagulant to mixing tests with lupus anticoagulant screen and confirm reagents can distinguish with high specificity between lupus anticoagulants and direct factor Xa inhibitors

Kumano, Osamu ORCID logoORCID: https://orcid.org/0000-0001-6650-0567, Amiral, Jean ORCID logoORCID: https://orcid.org/0000-0002-0680-9172, Dunois, Claire, Peyrafitte, Marie and Moore, Gary W. ORCID logoORCID: https://orcid.org/0000-0002-2987-281X (2021) Applying index of circulating anticoagulant to mixing tests with lupus anticoagulant screen and confirm reagents can distinguish with high specificity between lupus anticoagulants and direct factor Xa inhibitors. International Journal of Laboratory Hematology, 43 (4) . pp. 771-778. ISSN 1751-5521 [Article] (doi:10.1111/ijlh.13571)

Abstract

Background
Lupus anticoagulants (LA) are detected by prolongation of clotting times for dilute Russell's viper venom time (dRVVT) and activated partial thromboplastin time (APTT) screening tests. Direct oral anticoagulants (DOACs) can interfere with both screening and confirmatory tests. The present study aimed to investigate the influence of direct factor Xa inhibitors (DiXaIs) on screen, confirm and mixing tests and establish a method for differentiation from other sample types.

Materials and methods
A total of 257 samples including nonanticoagulated LA positive, LA positive with DiXaIs, factor deficiency, FVIII inhibitors, warfarin and non-APS DiXaIs were tested. APTT reagents Cephen LS/Cephen and dRVVT reagents LA1/LA2 were used, respectively, to screen/confirm the study group. Index of circulating anticoagulant (ICA) was calculated from clotting times based on the following formula as ICA screening and ICA confirmation. ICA= (1:1 Mix sample – Normal pooled plasma) / Screen patient x 100. An ICA matrix was established which suggested the presence of a DiXaI when both ICA screening and confirmation were above the cut-off. When only ICA screening is elevated, LA is suspected.

Results
Sensitivity and specificity of the ICA matrix were 52.2% and 92.8% for DiXaIs and 38.1% and 96.7% for LA in APTT, and 61.2% and 92.9% for DiXaIs and 22.2% and 88.4% for LA in dRVVT, respectively.

Conclusion
The ICA matrix achieved high specificity with a lower apparent sensitivity for DiXaI samples comparatively to other devices but due only to less interferences: the matrix could contribute to differentiating DiXaIs from LA in samples where anticoagulation status is unknown.

Item Type: Article
Keywords (uncontrolled): Clinical Biochemistry, Hematology, Biochemistry, medical, General Medicine
Research Areas: A. > School of Science and Technology
Item ID: 33288
Useful Links:
Depositing User: Jisc Publications Router
Date Deposited: 21 May 2021 09:20
Last Modified: 08 Sep 2021 12:03
URI: https://eprints.mdx.ac.uk/id/eprint/33288

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