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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...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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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. |
format | Online Article Text |
id | pubmed-7059445 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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