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Abstract
Background:
The presence of lupus anticoagulants (LA) is a strong risk factor for thrombosis in antiphospholipid syndrome. We investigated the usefulness of addition of silica clotting time (SCT) to the pre-existing dilute Russell's viper venom test (dRVVT) for detection of LA. Also, we analyzed differences in the thrombotic features and the characteristics of antiphospholipid antibodies between dRVVT and SCT.
Methods:
A total of 167 patients positive for LA or anti-cardiolipin (anti-CL) antibody and 76 healthy controls were enrolled. The dRVVT and SCT were used for detection of LA. Anti-CL, anti-β2-glycoprotein I (anti-β2 GPI) and anti-prothrombin (anti-PT) antibodies were measured using commercial ELISA kits.
Results:
In detection of thrombosis, the sensitivity of the combined test of SCT and dRVVT was 56.4%, which was higher than that of dRVVT alone (46.2%) or SCT alone (23.1%). The specificity of the combined test (80.9%) was comparable to that of dRVVT (81.9%). Also, odds ratio for predicting thrombosis was higher in the combined test than in dRVVT or SCT alone. When normalized LA ratio of the two tests was compared, the group of patients with higher ratio of SCT showed significantly higher prevalence of recurrent abortion and higher positivity of IgG types of anti-CL, anti-β2 GPI and anti-PT than the group with higher ratio of dRVVT.
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Fig. 1.
Comparison of IgG values of anti-CL (A), anti-β2 GPI (B) and anti-PT (C) in patients with lupus anticoagulant classified according to detection methods of lupus anticoagulant. The mean levels of anti-CL and anti-β2 GPI show significantly higher values in SCT group than in dRVVT group (P=0.016 and P=0.043, respectively). Box and whisker graphs shows median, 25th and 75th percentiles, range and outliers (circles and asterisks) of IgG values.
Abbreviations: See Table 4.
Table 1.
Characteristics of studied population
Table 2.
Sensitivity and specificity according to detection methods of lupus anticoagulant in predicting thrombosis
| Thrombosis | Sensitivity (%) | Specificity (%) | ||
|---|---|---|---|---|
| Present (N=39) | Absent (N=204) | |||
| dRVVT | ||||
| Positive | 18 (46.2%) | 37 (18.1%) | 46.2 | 81.9 |
| Negative | 21 (53.8%) | 167 (81.9%) | ||
| SCT | ||||
| Positive | 9 (23.1%) | 16 (7.8%) | 23.1 | 92.2 |
| Negative | 30 (76.9%) | 188 (92.2%) | ||
| dRVVT or SCT∗ | ||||
| Positive | 22 (56.4%) | 39 (19.1%) | 56.4 | 80.9 |
| Negative | 17 (43.6%) | 165 (80.9%) | ||
Table 3.
Odds ratios according to detection methods of lupus anticoagulant for predicting thrombosis
| Odds ratio (95% confidence interval) | P value | |
|---|---|---|
| dRVVT | ||
| Negative | 1∗ | |
| Positive | 5.94 (2.59-13.62) | <0.001 |
| SCT | ||
| Negative | 1∗ | |
| Positive | 5.10 (1.81-14.37) | 0.002 |
| dRVVT or SCT† | ||
| Negative | 1∗ | |
| Positive | 8.75 (3.79-20.19) | <0.001 |
Table 4.
Clinical features and antiphospholipid profile of 61 patients with lupus anticoagulant classified according to detection methods of lupus anticoagulant
| dRVVT group∗ (N=44) | SCT group† (N=17) | P value | |
|---|---|---|---|
| Age (yr) | |||
| Mean±SD | 33.9±18.7 | 34.2±21.8 | NS |
| Sex | |||
| M:F | 17:27 | 6:11 | NS |
| Clinical features | |||
| Arterial thrombosis | 6/44 (13.6%) | 2/17 (11.8%) | NS |
| Venous thrombosis | 6/44 (13.6%) | 1/17 (5.9%) | NS |
| Recurrent abortion | 2/44 (4.5%) | 5/17 (29.4%) | 0.015 |
| aCL | |||
| IgG | 5/44 (11.4%) | 7/17 (41.2%) | 0.026 |
| IgM | 7/44 (15.9%) | 3/17 (17.6%) | NS |
| Total‡ | 10/44 (22.7%) | 7/17 (41.2%) | NS |
| anti-β2GPI | |||
| IgG | 2/44 (4.5%) | 5/17 (29.4%) | 0.015 |
| IgM | 3/44 (6.8%) | 1/17 (5.9%) | NS |
| IgA | 7/44 (15.9%) | 5/17 (29.4%) | NS |
| Total‡ | 10/44 (22.7%) | 7/17 (41.2%) | NS |
| anti-PT | |||
| IgG | 6/44 (13.6%) | 7/17 (41.2%) | 0.033 |
| IgM | 1/39 (2.6%) | 0/12 (0.0%) | NS |
| Total‡ | 7/40 (17.5%) | 4/14 (28.6%) | NS |
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