Testing strategies for diagnosing lupus anticoagulant: decision analysis

Area of Science:

• Hematology
• Clinical Chemistry
• Medical Decision Making

Background:

• Lupus anticoagulant (LA) testing is crucial for patients with thrombosis or prolonged activated partial thromboplastin time (aPTT).
• Current diagnostic strategies for LA involve various combinations of coagulation assays.
• Optimizing LA detection requires evaluating cost-effectiveness and patient utility.

Purpose of the Study:

• To evaluate and compare different diagnostic strategies for lupus anticoagulant (LA) detection.
• To determine the most cost-effective and highest utility strategies for LA testing in specific clinical settings.
• To inform potential modifications in current clinical practices for LA evaluation.

Main Methods:

• Decision-modeling techniques, including a decision tree with 12 distinct LA detection strategies.
• Incorporation of activated partial thromboplastin time (aPTT), dilute Russell viper venom times (dRVVT), tissue thromboplastin time (TTI), and other assays.
• Utilized literature data for probabilities, costs, and patient utilities to model outcomes.

Main Results:

• The least costly strategy for patients with thrombosis or prolonged aPTT is no testing.
• For patients with systemic lupus erythematosus (SLE), not testing is least expensive, but TTI alone is also efficient.
• TTI followed by dRVVT provides the highest utility for SLE patients.

Conclusions:

• Current clinician strategies for LA detection may require modification based on cost-effectiveness and patient utility.
• The optimal strategy for LA detection varies depending on the clinical context and patient population.
• Further validation of modified LA detection strategies through clinical trials is recommended.