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

Abstract 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), enox...

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Autores principales:	Pieter M.M. De Kesel, Katrien M.J. Devreese
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2020
Materias:	carbon danaparoid enoxaparin heparin lupus coagulation inhibitor Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/d9f3dd16e8a044c4ace17787990932e3
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spelling	oai:doaj.org-article:d9f3dd16e8a044c4ace17787990932e32021-11-15T06:10:44ZThe effect of unfractionated heparin, enoxaparin, and danaparoid on lupus anticoagulant testing: Can activated carbon eliminate false‐positive results?2475-037910.1002/rth2.12264https://doaj.org/article/d9f3dd16e8a044c4ace17787990932e32020-01-01T00:00:00Zhttps://doi.org/10.1002/rth2.12264https://doaj.org/toc/2475-0379Abstract 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.Pieter M.M. De KeselKatrien M.J. DevreeseWileyarticlecarbondanaparoidenoxaparinheparinlupus coagulation inhibitorDiseases of the blood and blood-forming organsRC633-647.5ENResearch and Practice in Thrombosis and Haemostasis, Vol 4, Iss 1, Pp 161-168 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	carbon danaparoid enoxaparin heparin lupus coagulation inhibitor Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	carbon danaparoid enoxaparin heparin lupus coagulation inhibitor Diseases of the blood and blood-forming organs RC633-647.5 Pieter M.M. De Kesel Katrien M.J. Devreese The effect of unfractionated heparin, enoxaparin, and danaparoid on lupus anticoagulant testing: Can activated carbon eliminate false‐positive results?
description	Abstract 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.
format	article
author	Pieter M.M. De Kesel Katrien M.J. Devreese
author_facet	Pieter M.M. De Kesel Katrien M.J. Devreese
author_sort	Pieter M.M. De Kesel
title	The effect of unfractionated heparin, enoxaparin, and danaparoid on lupus anticoagulant testing: Can activated carbon eliminate false‐positive results?
title_short	The effect of unfractionated heparin, enoxaparin, and danaparoid on lupus anticoagulant testing: Can activated carbon eliminate false‐positive results?
title_full	The effect of unfractionated heparin, enoxaparin, and danaparoid on lupus anticoagulant testing: Can activated carbon eliminate false‐positive results?
title_fullStr	The effect of unfractionated heparin, enoxaparin, and danaparoid on lupus anticoagulant testing: Can activated carbon eliminate false‐positive results?
title_full_unstemmed	The effect of unfractionated heparin, enoxaparin, and danaparoid on lupus anticoagulant testing: Can activated carbon eliminate false‐positive results?
title_sort	effect of unfractionated heparin, enoxaparin, and danaparoid on lupus anticoagulant testing: can activated carbon eliminate false‐positive results?
publisher	Wiley
publishDate	2020
url	https://doaj.org/article/d9f3dd16e8a044c4ace17787990932e3
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The effect of unfractionated heparin, enoxaparin, and danaparoid on lupus anticoagulant testing: Can activated carbon eliminate false‐positive results?

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