Recent guidelines and recommendations for laboratory detection of lupus anticoagulants

Semin Thromb Hemost. 2014 Mar;40(2):163-71. doi: 10.1055/s-0033-1364185. Epub 2014 Feb 5.


The International Society on Haemostasis and Thrombosis (ISTH) and the British Committee for Standards in Haematology (BCSH) have recently updated their lupus anticoagulant (LA) detection guidelines. The Clinical and Laboratory Standards Institute (CLSI) subsequently will publish its first LA guideline. General agreement exists on issues such as sample preparation, the use of dilute Russell viper venom time (dRVVT) in diagnostic repertoires, the use of normalized ratios, calculations to demonstrate phospholipid dependence, calculations to demonstrate inhibition, and interpretive reporting. The ISTH recommendation to employ only dRVVT and activated partial thromboplastin time is not mirrored in the BCSH and CLSI documents. The potential for false negatives in mixing tests is acknowledged by all panels, yet they remain mandated by ISTH as there are occasions when they are crucial to diagnostic accuracy. BCSH indicates that a negative mixing test need not exclude the presence of a LA, and CLSI reprioritizes test order to screen-confirm-mix, the latter being considered unnecessary in specific circumstances. Opinions in the guidelines differ on setting cutoff levels (i.e., 97.5th vs. 99th percentile for normally distributed data). All guidelines cover testing of anticoagulated patients, more detail being given by BCSH and CLSI, who suggest that Taipan snake venom time is a useful adjunct test in patients receiving vitamin K antagonists. Although complete agreement is not apparent, the guidelines represent significant moves toward engendering common practices.

MeSH terms

  • Anticoagulants / therapeutic use
  • Antiphospholipid Syndrome / blood
  • Antiphospholipid Syndrome / diagnosis*
  • Antiphospholipid Syndrome / drug therapy
  • Blood Coagulation Tests / methods
  • Blood Coagulation Tests / standards
  • Clinical Laboratory Techniques / methods
  • Clinical Laboratory Techniques / standards*
  • Guidelines as Topic / standards*
  • Humans
  • Lupus Coagulation Inhibitor / blood*
  • Reagent Kits, Diagnostic / standards
  • Reproducibility of Results
  • Sensitivity and Specificity


  • Anticoagulants
  • Lupus Coagulation Inhibitor
  • Reagent Kits, Diagnostic