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Measurement of Factor V Activity in Human Plasma Using a Microplate Coagulation Assay
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Activated protein C resistance testing for factor V Leiden.

Stephan Kadauke1, Bernard Khor, Elizabeth M Van Cott

  • 1Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

American Journal of Hematology
|October 9, 2014
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Activated protein C resistance assays detect factor V Leiden accurately, but certain medications and lupus anticoagulants can interfere. Dilution assays improve accuracy by mitigating interferences from various conditions.

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Area of Science:

  • Hematology
  • Clinical Chemistry
  • Thrombosis Research

Background:

  • Activated protein C resistance (APC-R) assays are crucial for detecting factor V Leiden, a common genetic risk factor for thrombosis.
  • Current APC-R assays exhibit variability in accuracy and are susceptible to interference from various factors.
  • Understanding assay limitations is vital for accurate diagnosis and patient management.

Purpose of the Study:

  • To evaluate the accuracy of different activated protein C resistance assays in detecting factor V Leiden.
  • To identify common interfering substances and conditions affecting assay results.
  • To discuss the advantages and disadvantages of available APC-R testing methods.

Main Methods:

  • Review of current literature on activated protein C resistance assays.
  • Analysis of factors influencing assay performance, including direct oral anticoagulants (DOACs) and lupus anticoagulants.
  • Discussion of assay methodologies, particularly those involving dilution into factor V-deficient plasma.

Main Results:

  • Activated protein C resistance assays can accurately detect factor V Leiden, with performance varying by method.
  • Factor Xa inhibitors (e.g., rivaroxaban) and direct thrombin inhibitors (e.g., dabigatran) can lead to falsely normal APC-R results.
  • Lupus anticoagulants commonly cause inaccurate results across most current assays.
  • Dilution assays utilizing factor V-deficient plasma effectively minimize interference from factor deficiencies or elevations.

Conclusions:

  • The accuracy of activated protein C resistance assays for factor V Leiden detection is method-dependent.
  • Interference from anticoagulants and lupus anticoagulants necessitates careful interpretation of results.
  • Assays incorporating dilution into factor V-deficient plasma offer improved reliability by mitigating various interfering conditions.