|Biologie des anomalies de l'hémostase : détection d'un anticoagulant de type lupique [Biology of haemostasis disorders: lupus anticoagulant detection]
|Haute Autorité de Santé
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Haute Autorité de Santé. Biologie des anomalies de l'hémostase : détection d'un anticoagulant de type lupique. [Biology of haemostasis disorders: lupus anticoagulant detection]
. Paris: Haute Autorité de Santé (HAS). 2011
The National Salaried Workers' Health Insurance Fund (CNAMTS) asked HAS to assess the value of the different laboratory tests for haemostasis abnormalities with a view to updating the section in the Nomenclature of Procedures in Laboratory Medicine (NABM) containing the procedures in laboratory medicine for measuring abnormalities of haemostasis (subsection 5-02). One of those procedures is detection of the lupus anticoagulant.
Venous thromboembolism (VTE), the two main forms of which are deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a complex disorder resulting from the interaction of numerous genetic and environmental risk factors which constitute an individual's predisposition to thrombotic events. In France, the annual incidence of VTE is said to be 120 per 100,000, that of PE between 60 and 111 per 100,000. VTE is responsible for a mortality rate of 7.2 per 100,000. In pregnant women, the prevalence of VTE is 1 case per 1000 to 2000 pregnancies. Numerous studies have shown that there is a connection between VTE and biological risk factors (BRF), including antiphospholipid syndrome (APLS) which is one of the acquired causes of thrombophilia and thus of VTE.
APLS is defined by the combination of:
- one clinical criterion: vascular thrombosis or obstetric disease;
- and one laboratory criterion showing the presence of heterogeneous antiphospholipid antibodies: anticardiolipin (aCL), anti-β2 glycoprotein 1 antibody (anti-β2GP 1) or lupus anticoagulant (LA).
According to the various documents analysed, lupus anticoagulant is detected in several phases: screening, demonstration of an inhibitory effect, and confirmation. It requires the performance of two coagulation tests (at the screening phase) based on different principles:
- the recommended tests are, firstly, dilute Russell's viper venom time (dRVVT) and, secondly, activated partial thromboplastin time (aPTT) using silica in the presence of low concentrations of phospholipids;
- the indications for the detection of lupus anticoagulant are generally vascular thromboses (venous or arterial thromboembolic accident in elderly patients, provoked venous thromboembolic accident in a young patient, unprovoked venous thromboembolic accident or unexplained arterial thromboembolic accident in young patients under 50 years of age, thromboses at unusual sites, thrombosis in patients with an autoimmune disorder, first episode of unprovoked VTE occurring before age 60 years, VTE, whether or not provoked, in
women of child-bearing age, any recurrence of proximal DVT and/or provoked or unprovoked PE, the first episode of which occurred before age 60 years, any recurrence of unprovoked distal DVT, episode of DVT or PE with no obvious cause, recurrence of DVT or PE, cerebral vascular accident or peripheral arterial thrombosis in the absence of any risk factors, recurring arterial thromboses despite preventive anticoagulant treatment, systemic lupus erythematosus) and/or obstetric disorders (multiple spontaneous abortions, late intrauterine death in patients with an autoimmune disease, early or severe preeclampsia or severe placental insufficiency, unexplained intrauterine death, severe unexplained intrauterine growth retardation in women with a history of VTE and in asymptomatic pregnant women with a family history of VTE or hereditary thrombophilia);
- it is recommended that a positive test should be repeated at least 12 weeks after the initial test to check whether lupus anticoagulant is still present;
- the result must always include a complete laboratory assessment of the APLS profile with a check for anticardiolipin and anti-β2 glycoprotein 1 antibodies (NABM code 1460);
- the reports on the results must be easy to interpret. It is important for these tests to be carried out at experienced laboratories and repeated in the same laboratory.
INAHTA brief and checklist
Subject indexing assigned by CRD
Antiphospholipid Syndrome; Blood Coagulation Disorders; Hemostasis; Humans; Lupus Coagulation Inhibitor
Country of organisation
An English language summary is available.
Address for correspondence
French National Authority for Health, 2, avenue du Stade de France, Saint-Denis La Plaine, FR-93218 Paris France
Tel: +33 1 55 937188 Email: firstname.lastname@example.org
Date abstract record published