Mixing studies for lupus anticoagulant: mostly yes, sometimes no

Lupus anticoagulants (LAs) represent one manifestation of the clinical condition called antiphospholipid syndrome (APS) and are associated with many adverse clinical outcomes, but primarily with thrombosis and/or pregnancy morbidity. LAs are identified by laboratory testing, principally using clot-based assays based on Russell viper venom time (RVVT) and activated partial thromboplastin time (APTT) test methods. All three of the most recent guidance documents for LA testing recommend using these tests, although they vary in regard to inclusion/exclusion of other test processes. Mixing studies form part of the process of LA identification/exclusion, since in vitro LAs act like coagulation inhibitors. Mixing studies are also supported by all three LA guidance documents, but recommendations vary in regard to relative importance and placement in the LA identification/exclusion algorithm. This Point article takes the position that mixing tests are usually indicated for appropriate identification/exclusion of LAs, but can occasionally be omitted.