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Escaping the catch 22 of lupus anticoagulant testing

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 fo...

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Autores principales: Vinholt, Pernille Just, Just, Søren Andreas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059445/
https://www.ncbi.nlm.nih.gov/pubmed/32144138
http://dx.doi.org/10.1136/rmdopen-2019-001156
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author Vinholt, Pernille Just
Just, Søren Andreas
author_facet Vinholt, Pernille Just
Just, Søren Andreas
author_sort Vinholt, Pernille Just
collection PubMed
description 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.
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spelling pubmed-70594452020-03-20 Escaping the catch 22 of lupus anticoagulant testing Vinholt, Pernille Just Just, Søren Andreas RMD Open Lupus 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. BMJ Publishing Group 2020-03-05 /pmc/articles/PMC7059445/ /pubmed/32144138 http://dx.doi.org/10.1136/rmdopen-2019-001156 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Lupus
Vinholt, Pernille Just
Just, Søren Andreas
Escaping the catch 22 of lupus anticoagulant testing
title Escaping the catch 22 of lupus anticoagulant testing
title_full Escaping the catch 22 of lupus anticoagulant testing
title_fullStr Escaping the catch 22 of lupus anticoagulant testing
title_full_unstemmed Escaping the catch 22 of lupus anticoagulant testing
title_short Escaping the catch 22 of lupus anticoagulant testing
title_sort escaping the catch 22 of lupus anticoagulant testing
topic Lupus
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059445/
https://www.ncbi.nlm.nih.gov/pubmed/32144138
http://dx.doi.org/10.1136/rmdopen-2019-001156
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