Seheult Jansen N, Meyer Michael P, Bontempo Franklin A, Chibisov Irina
From the Department of Pathology and.
Coagulation Laboratory, Institute for Transfusion Medicine, Pittsburgh, PA.
Am J Clin Pathol. 2017 Jun 1;147(6):632-640. doi: 10.1093/ajcp/aqx035.
To investigate the effects of indirect- and direct-acting anticoagulants on the interpretation of lupus anticoagulant (LAC) assays.
A retrospective database review was performed to identify all LAC panels from November 2012 to November 2015. The positivity rates for three LAC tests were compared among various anticoagulant medications.
This analysis included 7,721 LAC panels. Direct oral anticoagulants, warfarin, and unfractionated heparin (UFH) were associated with higher LAC positivity rates compared with patients not receiving documented anticoagulation (83% for argatroban, 58% for dabigatran, 72% for rivaroxaban, 53% for apixaban, 56% for warfarin, and 36% for UFH vs 29% for no anticoagulation, P < .025). Direct thrombin inhibitors mainly affected the activated partial thromboplastin time-based assays and the tissue thromboplastin inhibition index (TTI), while direct factor Xa inhibitors mainly affected the TTI and the dilute Russell viper venom ratio.
Results of LAC testing performed while patients are receiving anticoagulant therapies should be interpreted with caution to avoid misdiagnosing patients with the antiphospholipid syndrome and potentially committing them to long-term anticoagulation therapy.
研究间接作用和直接作用抗凝剂对狼疮抗凝物（LAC）检测结果解读的影响。
进行一项回顾性数据库分析，以确定2012年11月至2015年11月期间所有的LAC检测项目。比较了不同抗凝药物之间三种LAC检测的阳性率。
该分析纳入了7721个LAC检测项目。与未接受记录在案的抗凝治疗的患者相比，直接口服抗凝剂、华法林和普通肝素（UFH）与更高的LAC阳性率相关（阿加曲班为83%，达比加群为58%，利伐沙班为72%，阿哌沙班为53%，华法林为56%，UFH为36%，未抗凝者为29%，P <.025）。直接凝血酶抑制剂主要影响基于活化部分凝血活酶时间的检测和组织凝血活酶抑制指数（TTI），而直接Xa因子抑制剂主要影响TTI和稀释蝰蛇毒时间比值。
在患者接受抗凝治疗时进行的LAC检测结果应谨慎解读，以避免将抗磷脂综合征患者误诊，并可能使其接受长期抗凝治疗。
