The effect of unfractionated heparin, enoxaparin, and danaparoid on lupus anticoagulant testing: Can activated carbon eliminate false‐positive results?

BACKGROUND: Heparins and heparinoids interfere with functional clotting assays used for lupus anticoagulant (LAC) detection. However, current guidelines for LAC testing do not provide clear guidance on this matter. OBJECTIVES: We aimed to assess to effect of unfractionated heparin (UFH), enoxaparin, and danaparoid on LAC assays over broad anti‐Xa activity ranges and to evaluate whether activated carbon (AC) is able to neutralize these effects. METHODS: UFH (0.1‐3.0 IU/mL), enoxaparin (0.2‐2.9 IU/mL), and danaparoid (0.6‐2.2 IU/mL) were spiked to normal pooled plasma. AC was added at multiple activity levels. Anti‐Xa assays and LAC tests were performed on all samples using Stago analyzers and reagents. RESULTS: Abnormal activated partial thromboplastin time (APTT) screening and mixing tests were obtained at the lowest levels for all compounds. Abnormal APTT confirmation tests were seen from 2.5 and 1.9 anti‐Xa IU/mL for enoxaparin and danaparoid, respectively. Abnormal dilute Russell’s viper venom test (dRVVT) screening tests were obtained from 1.6, 1.4, and 1.1 anti‐Xa IU/mL for UFH, enoxaparin, and danaparoid, respectively. Mixing tests were abnormal from 2.5 and 1.3 anti‐Xa IU/mL for enoxaparin and danaparoid, respectively. Abnormal dRVVT confirmation results were seen for danaparoid only from 1.9 anti‐Xa IU/mL. AC was unable to neutralize anti‐Xa activity in plasma and overcome the effect of the tested anticoagulants on LAC assays but may cause prolongation of APTT clotting times. CONCLUSIONS: UFH, enoxaparin, and danaparoid clearly affected LA tests; however, false‐positive LAC conclusions were obtained at supratherapeutic enoxaparin and danaparoid levels only. AC may prolong APTT screen clotting times, requiring 3‐step testing to avoid potential misdiagnosis of LAC.