Moore Gary W, Smith Mark P, Savidge Geoffrey F
Haemophilia Research Centre, Centre for Thrombosis and Haemostasis, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
Blood Coagul Fibrinolysis. 2003 Apr;14(3):307-12. doi: 10.1097/01.mbc.0000061283.28953.39.
The Taipan snake venom time using dilute phospholipid as a screening test with a platelet neutralization procedure as a confirmatory test has been shown to be a sensitive and specific approach to detection of lupus anticoagulants. Taipan venom is largely insensitive to the effects of ongoing warfarin anticoagulation and this can be useful in detection of lupus anticoagulants in patients receiving this treatment. This study compared the use of the platelet neutralization procedure with the Ecarin time as confirmatory tests for the Taipan snake venom time, the Ecarin venom fraction being insensitive to both lupus anticoagulants and the effects of oral anticoagulants. Screening and confirmatory test data were assessed for phospholipid dependence by three different mathematical methods and there was no advantage in using the Ecarin time in detection of 'uncomplicated' lupus anticoagulants. In lupus anticoagulant-positive warfarinized patients, the Ecarin time achieved higher detection rates than the platelet neutralization procedure irrespective of the method used to assess correction. The Ecarin time confirmed lupus anticoagulants in all of those samples that generated elevated Taipan snake venom time ratios whereas the platelet neutralization procedure identified only 33%. Taipan snake venom time plus Ecarin time offers good diagnostic precision for lupus anticoagulant detection in a group of patients where lupus anticoagulant identification is difficult due to ongoing anticoagulation.
以稀释磷脂作为筛选试验、血小板中和程序作为确证试验的太攀蛇毒时间，已被证明是检测狼疮抗凝物的一种敏感且特异的方法。太攀蛇毒在很大程度上不受正在进行的华法林抗凝作用的影响，这在检测接受该治疗患者的狼疮抗凝物时很有用。本研究比较了血小板中和程序与蝰蛇毒时间作为太攀蛇毒时间确证试验的应用情况，蝰蛇毒组分对狼疮抗凝物和口服抗凝剂的作用均不敏感。通过三种不同数学方法评估筛选和确证试验数据的磷脂依赖性，在检测“单纯性”狼疮抗凝物方面，使用蝰蛇毒时间并无优势。在狼疮抗凝物阳性的华法林化患者中，无论采用何种方法评估校正情况，蝰蛇毒时间的检测率均高于血小板中和程序。蝰蛇毒时间在所有太攀蛇毒时间比值升高的样本中均确证了狼疮抗凝物，而血小板中和程序仅识别出33%。在一组因正在进行抗凝而难以识别狼疮抗凝物的患者中，太攀蛇毒时间加蝰蛇毒时间为狼疮抗凝物检测提供了良好的诊断准确性。
