Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
Section of Rheumatology, Department of Medicine, Svendborg Hospital - Odense University Hospital, Svendborg, Denmark.
RMD Open. 2020 Jan;6(1). doi: 10.1136/rmdopen-2019-001156.
High-risk patients with antiphospholipid syndrome (APS) experience increased risk of thrombosis when treated with direct oral anticoagulant (DOAC) therapy compared with warfarin. It is essential to establish the APS diagnosis to choose therapy and determine treatment duration. It requires testing for antiphospholipid antibodies, including lupus anticoagulant (LAC). In this viewpoint, we discuss the options for timing of LAC testing, which includes testing before starting anticoagulant treatment (DOAC or warfarin), after switching to heparin or after withdrawal of anticoagulant treatment. DOACs interfere with LAC testing and recommendations emerge stating not to conduct on-therapy LAC testing. All approaches are to some extent currently practised, but have limitations and the area is therefore seemingly a catch 22. We put forward that the anticoagulant effect of DOAC can be eliminated in the laboratory and therefore patients can be tested on-therapy. While it may not eliminate all cases of interference, it could aid the interpretation in these situations and this approach is attractive from the patient and clinician's perspective. Nevertheless, to prevent misdiagnosis the diagnostic workup for APS requires collaboration between the clinician and the laboratory. We advocate for standardisation in laboratory and clinical practice when diagnosing APS.
与华法林相比，接受直接口服抗凝剂 (DOAC) 治疗的抗磷脂综合征 (APS) 高危患者发生血栓的风险增加。确定 APS 诊断以选择治疗方法并确定治疗持续时间至关重要。这需要检测抗磷脂抗体，包括狼疮抗凝剂 (LAC)。在本观点中，我们讨论了 LAC 检测的时间选择，包括在开始抗凝治疗（DOAC 或华法林）之前、转换为肝素或停止抗凝治疗后进行检测。DOAC 会干扰 LAC 检测，有建议指出不要进行治疗中的 LAC 检测。所有方法在某种程度上目前都在实施，但都有局限性，因此该领域似乎陷入了困境。我们提出，DOAC 的抗凝作用可以在实验室中消除，因此可以对治疗中的患者进行检测。虽然它可能无法消除所有干扰情况，但可以帮助在这些情况下进行解释，从患者和临床医生的角度来看，这种方法很有吸引力。然而，为了防止误诊，APS 的诊断需要临床医生和实验室之间的合作。我们主张在诊断 APS 时在实验室和临床实践中实现标准化。
