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As seen in Table 1, her laboratory workup showed prolonged DRVVT in both screening and mixing assays and an increased DRVVT confirmation ratio, suggesting the presence of lupus-like anticoagulant according to the updated guidelines for LA detection (5).
While no single test is sensitive for all lupus anticoagulants, the latest guidelines from the International Society on Thrombosis and Haemostasis recommended the DRVVT and sensitive silica based APTT, rather than the KCT.
Tests utilized to diagnose APS include coagulation assays (APTT, KCT, dRVVT) and ELISAs for the detection of cardiolipin and [[beta].sub.2]-GPI antibodies.
Three different commercial dRVVT reagents [dRVVT1, DVVtest/DVVconfirm (American Diagnostica); dRVVT2, LACscreen/LACconfirm (Instrumentation Laboratory); dRVVT3, LA1/LA2 (Dade Behring)] were used by a reasonable number of participants to make subgroup analyses.
These tests have been investigated extensively because there are many commercial methods available that are based on the activation of endogenous PC by snake venom (e.g., Protac) and on the performance of paired clotting tests (PT, APTT, or dRVVT).
Among the whole population of hemophiliacs for whom results were available, 0 of 49 (0%), 8 of 47 (17%),1 of 49 (2%), and 9 of 47 (19%) patients were positive according to the home-made dRVVT, commercial dRVVT, SCT, and StaClot-LA, respectively.
We wished to compare these 2 approaches by using the common (4) dilute Russell viper venom test (dRVVT) as the clotting assay.
Lupus anticoagulant confirmation testing was considered positive when the difference between both aPTT-LA clotting times was greater than 8 seconds ([aPTT-LA.sub.Difference], Staclot LA [Diagnostica Stago S.A.S, Asnieres sur Seine, France]) or the ratio between the neat diluted Russell viper venom time (dRVVT) and the [dRVVT.sub.Confirm] ([dRVVT.sub.Ratio], Staclot DRVV Screen/Staclot DRVV Confirm) was greater than 1.25.
An APA assay showed an elevated IgM level for [beta]-2-glycoprotein I antibody (64.1 MPL, normal < 15); aCL antibodies were not detected and a Dilute Russel Viper Venom Time (DRVVT) was normal.
Responsiveness (but not linearity) to increasing dose is adequate: A rivaroxaban concentration of 200 [micro]g/L prolongs the basal value by about 3 times and 2.5 times when measured with the Heptest and the dRVVT, respectively (20).
And we are one of the few manufacturers of the dilute Russell's viper venom time test (dRVVT) in the world.
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