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Laboratory Diagnosis of Antiphospholipid Syndrome in Anticoagulated Patients

Armando Tripodi1,2, Erica Scalambrino1, Marigrazia Clerici1

  • 1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy.

Biomedicines
|June 28, 2023
PubMed

Insights

Diagnosing antiphospholipid syndrome (APS) is challenging in patients on anticoagulation therapy. This review explores how anticoagulants affect APS diagnostic tests and discusses strategies to overcome these interferences for accurate patient assessment.

Area of Science:

  • Immunology
  • Hematology
  • Clinical Diagnostics

Background:

  • Antiphospholipid syndrome (APS) diagnosis relies on detecting specific antibodies and lupus anticoagulant (LA).
  • Anticoagulant medications complicate the interpretation of laboratory tests for APS, particularly LA.
  • Accurate APS diagnosis is crucial for guiding secondary antithrombotic prophylaxis decisions.

Purpose of the Study:

  • To review the impact of anticoagulant therapies on the laboratory diagnosis of APS.
  • To discuss methods for overcoming diagnostic interferences caused by anticoagulants in APS testing.

Main Methods:

  • Literature review focusing on the effects of anticoagulants on antiphospholipid antibody and lupus anticoagulant assays.
  • Analysis of diagnostic challenges and proposed solutions for APS diagnosis in anticoagulated patients.

Main Results:

  • Anticoagulants can prolong clotting times, mimicking or masking the effects of lupus anticoagulant.
  • Interference from anticoagulants necessitates specific testing strategies or modifications for reliable APS diagnosis.
  • Understanding these interferences is key to avoiding misdiagnosis and ensuring appropriate patient management.

Conclusions:

  • Anticoagulation significantly impacts the accuracy of laboratory tests used for diagnosing antiphospholipid syndrome.
  • Strategies exist to mitigate anticoagulant interference, enabling more reliable APS diagnosis in treated patients.
  • Further research and standardized protocols are needed to optimize APS diagnostics in anticoagulated individuals.

Keywords:
aPTTdRVVTdirect oral anticoagulantsheparinslupus anticoagulantwarfarin

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