Triple-positive antiphospholipid syndrome does not guarantee positivity in each lupus anticoagulant assay
Triple positivity for all 3 criteria antiphospholipid antibodies confers high risk of symptom development in carriers, and recurrence in antiphospholipid syndrome (APS). Most triple-positivity studies report lupus anticoagulant (LA) testing as positive without distinguishing between positivity with...
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| Veröffentlicht in: | Journal of thrombosis and haemostasis 2023-12, Vol.21 (12), p.3539-3546 |
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| creator | Moore, Gary W. Foxton, Eleanor Platton, Sean Yartey, Nada White, Danielle MacDonald, Stephen G. |
| description | Triple positivity for all 3 criteria antiphospholipid antibodies confers high risk of symptom development in carriers, and recurrence in antiphospholipid syndrome (APS). Most triple-positivity studies report lupus anticoagulant (LA) testing as positive without distinguishing between positivity with dilute Russell’s viper venom time (dRVVT) and activated partial thromboplastin time (APTT) and single-assay positivity or only perform dRVVT. Single LA assay repertoires remain in use in some centers, which risks missing some triple positives. Positivity with both assays may identify higher risk.
The aim of this study is to investigate the frequency of single LA assay positivity in triple-positive patients.
Three hundred forty-two triple-positive profiles from nonanticoagulated patients (237 APS, 45 systemic lupus erythematosus without APS symptoms, and 60 nonclinical criteria) were identified from laboratory databases and assessed for LA positivity by dRVVT and/or APTT.
Seventy-three of 237 (30.8%) APS samples were LA-positive with 1 assay, 40/237 (16.9%) by dRVVT only, and 33/237 (13.9%) with APTT only. Nineteen of 45 (42.2%) were LA-positive with 1 assay in the systemic lupus erythematosus cohort; 12/45 (26.7%) with dRVVT only and 7/45 (15.5%) with APTT only. Thirty-three of 60 (55.0%) were LA-positive with 1 assay in the nonclinical criteria cohort; 24/60 (40.0%) with dRVVT only and 9/60 (15.0%) with APTT only. The most common solid-phase assay profile was elevated immunoglobulin G aCL and aβ2GPI.
Up to 55.0% of triple-positive samples were positive in 1 LA assay, representing significant potential for misdiagnosis and inappropriate management via single LA assay repertoires.
•Triple antiphospholipid antibody positivity confers high risk of symptom development/recurrence.•Few studies report whether one or both commonly used lupus anticoagulant (LA) tests are positive.•One hundred twenty-five of 342 (36.6%) samples from triple-positive patients were LA-positive with only 1 assay.•Single LA assay testing risks missing triple positivity with potential to affect management. |
| doi_str_mv | 10.1016/j.jtha.2023.08.009 |
| format | Article |
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The aim of this study is to investigate the frequency of single LA assay positivity in triple-positive patients.
Three hundred forty-two triple-positive profiles from nonanticoagulated patients (237 APS, 45 systemic lupus erythematosus without APS symptoms, and 60 nonclinical criteria) were identified from laboratory databases and assessed for LA positivity by dRVVT and/or APTT.
Seventy-three of 237 (30.8%) APS samples were LA-positive with 1 assay, 40/237 (16.9%) by dRVVT only, and 33/237 (13.9%) with APTT only. Nineteen of 45 (42.2%) were LA-positive with 1 assay in the systemic lupus erythematosus cohort; 12/45 (26.7%) with dRVVT only and 7/45 (15.5%) with APTT only. Thirty-three of 60 (55.0%) were LA-positive with 1 assay in the nonclinical criteria cohort; 24/60 (40.0%) with dRVVT only and 9/60 (15.0%) with APTT only. The most common solid-phase assay profile was elevated immunoglobulin G aCL and aβ2GPI.
Up to 55.0% of triple-positive samples were positive in 1 LA assay, representing significant potential for misdiagnosis and inappropriate management via single LA assay repertoires.
•Triple antiphospholipid antibody positivity confers high risk of symptom development/recurrence.•Few studies report whether one or both commonly used lupus anticoagulant (LA) tests are positive.•One hundred twenty-five of 342 (36.6%) samples from triple-positive patients were LA-positive with only 1 assay.•Single LA assay testing risks missing triple positivity with potential to affect management.</description><identifier>ISSN: 1538-7836</identifier><identifier>EISSN: 1538-7836</identifier><identifier>DOI: 10.1016/j.jtha.2023.08.009</identifier><identifier>PMID: 37597725</identifier><language>eng</language><publisher>England: Elsevier Inc</publisher><subject>activated partial thromboplastin time ; Antibodies, Antiphospholipid ; antiphospholipid syndrome ; Antiphospholipid Syndrome - diagnosis ; Blood Coagulation Tests ; dilute Russell’s viper venom time ; Humans ; lupus anticoagulant ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic - diagnosis ; Partial Thromboplastin Time ; Prothrombin Time ; triple positive</subject><ispartof>Journal of thrombosis and haemostasis, 2023-12, Vol.21 (12), p.3539-3546</ispartof><rights>2023 International Society on Thrombosis and Haemostasis</rights><rights>Copyright © 2023 International Society on Thrombosis and Haemostasis. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-8b9413399b613ca3af200869abc0bcc72716f5d9dfa73b14c2e594a2e9d688243</citedby><cites>FETCH-LOGICAL-c356t-8b9413399b613ca3af200869abc0bcc72716f5d9dfa73b14c2e594a2e9d688243</cites><orcidid>0009-0001-0775-4759 ; 0000-0002-7711-6875 ; 0000-0002-2987-281X ; 0000-0002-5466-0448 ; 0009-0003-4339-4417 ; 0000-0002-4944-3289</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37597725$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Moore, Gary W.</creatorcontrib><creatorcontrib>Foxton, Eleanor</creatorcontrib><creatorcontrib>Platton, Sean</creatorcontrib><creatorcontrib>Yartey, Nada</creatorcontrib><creatorcontrib>White, Danielle</creatorcontrib><creatorcontrib>MacDonald, Stephen G.</creatorcontrib><title>Triple-positive antiphospholipid syndrome does not guarantee positivity in each lupus anticoagulant assay</title><title>Journal of thrombosis and haemostasis</title><addtitle>J Thromb Haemost</addtitle><description>Triple positivity for all 3 criteria antiphospholipid antibodies confers high risk of symptom development in carriers, and recurrence in antiphospholipid syndrome (APS). Most triple-positivity studies report lupus anticoagulant (LA) testing as positive without distinguishing between positivity with dilute Russell’s viper venom time (dRVVT) and activated partial thromboplastin time (APTT) and single-assay positivity or only perform dRVVT. Single LA assay repertoires remain in use in some centers, which risks missing some triple positives. Positivity with both assays may identify higher risk.
The aim of this study is to investigate the frequency of single LA assay positivity in triple-positive patients.
Three hundred forty-two triple-positive profiles from nonanticoagulated patients (237 APS, 45 systemic lupus erythematosus without APS symptoms, and 60 nonclinical criteria) were identified from laboratory databases and assessed for LA positivity by dRVVT and/or APTT.
Seventy-three of 237 (30.8%) APS samples were LA-positive with 1 assay, 40/237 (16.9%) by dRVVT only, and 33/237 (13.9%) with APTT only. Nineteen of 45 (42.2%) were LA-positive with 1 assay in the systemic lupus erythematosus cohort; 12/45 (26.7%) with dRVVT only and 7/45 (15.5%) with APTT only. Thirty-three of 60 (55.0%) were LA-positive with 1 assay in the nonclinical criteria cohort; 24/60 (40.0%) with dRVVT only and 9/60 (15.0%) with APTT only. The most common solid-phase assay profile was elevated immunoglobulin G aCL and aβ2GPI.
Up to 55.0% of triple-positive samples were positive in 1 LA assay, representing significant potential for misdiagnosis and inappropriate management via single LA assay repertoires.
•Triple antiphospholipid antibody positivity confers high risk of symptom development/recurrence.•Few studies report whether one or both commonly used lupus anticoagulant (LA) tests are positive.•One hundred twenty-five of 342 (36.6%) samples from triple-positive patients were LA-positive with only 1 assay.•Single LA assay testing risks missing triple positivity with potential to affect management.</description><subject>activated partial thromboplastin time</subject><subject>Antibodies, Antiphospholipid</subject><subject>antiphospholipid syndrome</subject><subject>Antiphospholipid Syndrome - diagnosis</subject><subject>Blood Coagulation Tests</subject><subject>dilute Russell’s viper venom time</subject><subject>Humans</subject><subject>lupus anticoagulant</subject><subject>Lupus Coagulation Inhibitor</subject><subject>Lupus Erythematosus, Systemic - diagnosis</subject><subject>Partial Thromboplastin Time</subject><subject>Prothrombin Time</subject><subject>triple positive</subject><issn>1538-7836</issn><issn>1538-7836</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1O4zAURq0Roykw8wIskJdsEvwTJ7bEBiEGkCqxYdaWY9-0rtI42AlS3x53WhArFle-i_N9uj4IXVBSUkLr6025mdamZITxksiSEPUDnVLBZdFIXp982RfoLKUNIVQJRn6hBW-EahomTpF_iX7soRhD8pN_A2yGyY_rkPL0fvQOp93gYtgCdgESHsKEV7OJGQPAx5SfdtgPGIxd434e5_S_xQazmvu8YZOS2f1GPzvTJ_hzfM_Rv7_3L3ePxfL54enudllYLuqpkK2qKOdKtTXl1nDTMUJkrUxrSWttwxpad8Ip15mGt7SyDISqDAPlailZxc_R1aF3jOF1hjTprU8W-nwJhDlpJgVXFedMZJQdUBtDShE6PUa_NXGnKdF7xXqj94r1XrEmUmfFOXR57J_bLbjPyIfTDNwcAMi_fPMQdbIeBgvOR7CTdsF_1_8OlU6PuA</recordid><startdate>202312</startdate><enddate>202312</enddate><creator>Moore, Gary W.</creator><creator>Foxton, Eleanor</creator><creator>Platton, Sean</creator><creator>Yartey, Nada</creator><creator>White, Danielle</creator><creator>MacDonald, Stephen G.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0009-0001-0775-4759</orcidid><orcidid>https://orcid.org/0000-0002-7711-6875</orcidid><orcidid>https://orcid.org/0000-0002-2987-281X</orcidid><orcidid>https://orcid.org/0000-0002-5466-0448</orcidid><orcidid>https://orcid.org/0009-0003-4339-4417</orcidid><orcidid>https://orcid.org/0000-0002-4944-3289</orcidid></search><sort><creationdate>202312</creationdate><title>Triple-positive antiphospholipid syndrome does not guarantee positivity in each lupus anticoagulant assay</title><author>Moore, Gary W. ; Foxton, Eleanor ; Platton, Sean ; Yartey, Nada ; White, Danielle ; MacDonald, Stephen G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-8b9413399b613ca3af200869abc0bcc72716f5d9dfa73b14c2e594a2e9d688243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>activated partial thromboplastin time</topic><topic>Antibodies, Antiphospholipid</topic><topic>antiphospholipid syndrome</topic><topic>Antiphospholipid Syndrome - diagnosis</topic><topic>Blood Coagulation Tests</topic><topic>dilute Russell’s viper venom time</topic><topic>Humans</topic><topic>lupus anticoagulant</topic><topic>Lupus Coagulation Inhibitor</topic><topic>Lupus Erythematosus, Systemic - diagnosis</topic><topic>Partial Thromboplastin Time</topic><topic>Prothrombin Time</topic><topic>triple positive</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Moore, Gary W.</creatorcontrib><creatorcontrib>Foxton, Eleanor</creatorcontrib><creatorcontrib>Platton, Sean</creatorcontrib><creatorcontrib>Yartey, Nada</creatorcontrib><creatorcontrib>White, Danielle</creatorcontrib><creatorcontrib>MacDonald, Stephen G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moore, Gary W.</au><au>Foxton, Eleanor</au><au>Platton, Sean</au><au>Yartey, Nada</au><au>White, Danielle</au><au>MacDonald, Stephen G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Triple-positive antiphospholipid syndrome does not guarantee positivity in each lupus anticoagulant assay</atitle><jtitle>Journal of thrombosis and haemostasis</jtitle><addtitle>J Thromb Haemost</addtitle><date>2023-12</date><risdate>2023</risdate><volume>21</volume><issue>12</issue><spage>3539</spage><epage>3546</epage><pages>3539-3546</pages><issn>1538-7836</issn><eissn>1538-7836</eissn><abstract>Triple positivity for all 3 criteria antiphospholipid antibodies confers high risk of symptom development in carriers, and recurrence in antiphospholipid syndrome (APS). Most triple-positivity studies report lupus anticoagulant (LA) testing as positive without distinguishing between positivity with dilute Russell’s viper venom time (dRVVT) and activated partial thromboplastin time (APTT) and single-assay positivity or only perform dRVVT. Single LA assay repertoires remain in use in some centers, which risks missing some triple positives. Positivity with both assays may identify higher risk.
The aim of this study is to investigate the frequency of single LA assay positivity in triple-positive patients.
Three hundred forty-two triple-positive profiles from nonanticoagulated patients (237 APS, 45 systemic lupus erythematosus without APS symptoms, and 60 nonclinical criteria) were identified from laboratory databases and assessed for LA positivity by dRVVT and/or APTT.
Seventy-three of 237 (30.8%) APS samples were LA-positive with 1 assay, 40/237 (16.9%) by dRVVT only, and 33/237 (13.9%) with APTT only. Nineteen of 45 (42.2%) were LA-positive with 1 assay in the systemic lupus erythematosus cohort; 12/45 (26.7%) with dRVVT only and 7/45 (15.5%) with APTT only. Thirty-three of 60 (55.0%) were LA-positive with 1 assay in the nonclinical criteria cohort; 24/60 (40.0%) with dRVVT only and 9/60 (15.0%) with APTT only. The most common solid-phase assay profile was elevated immunoglobulin G aCL and aβ2GPI.
Up to 55.0% of triple-positive samples were positive in 1 LA assay, representing significant potential for misdiagnosis and inappropriate management via single LA assay repertoires.
•Triple antiphospholipid antibody positivity confers high risk of symptom development/recurrence.•Few studies report whether one or both commonly used lupus anticoagulant (LA) tests are positive.•One hundred twenty-five of 342 (36.6%) samples from triple-positive patients were LA-positive with only 1 assay.•Single LA assay testing risks missing triple positivity with potential to affect management.</abstract><cop>England</cop><pub>Elsevier Inc</pub><pmid>37597725</pmid><doi>10.1016/j.jtha.2023.08.009</doi><tpages>8</tpages><orcidid>https://orcid.org/0009-0001-0775-4759</orcidid><orcidid>https://orcid.org/0000-0002-7711-6875</orcidid><orcidid>https://orcid.org/0000-0002-2987-281X</orcidid><orcidid>https://orcid.org/0000-0002-5466-0448</orcidid><orcidid>https://orcid.org/0009-0003-4339-4417</orcidid><orcidid>https://orcid.org/0000-0002-4944-3289</orcidid></addata></record> |
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| subjects | activated partial thromboplastin time Antibodies, Antiphospholipid antiphospholipid syndrome Antiphospholipid Syndrome - diagnosis Blood Coagulation Tests dilute Russell’s viper venom time Humans lupus anticoagulant Lupus Coagulation Inhibitor Lupus Erythematosus, Systemic - diagnosis Partial Thromboplastin Time Prothrombin Time triple positive |
| title | Triple-positive antiphospholipid syndrome does not guarantee positivity in each lupus anticoagulant assay |
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