Our September 2026 Quick Question is a poll that asks: In your facility, what AC is used for LAC patients with VTE?
AC therapy is indicated for VTE, including VTE and fetal loss associated with the presence of chronic LAC in the plasma. The commonly used anti-FXa DOACs are rivaroxaban (Xarelto®) and apixaban (Eliquis®). The only anti-FIIa (thrombin) DOAC is dabigatran (Pradaxa®), and the VKA warfarin is often used as it has long been found effective for LAC-associated VTE. ACs interfere with standard clot-based LAC profiles, limiting their usefulness or requiring special plasma treatment. Please choose the most often-used AC in your institution. We welcome comments about AC choices and the means available for treating plasma before performing the LAC profile.
Hi George, assuming you mean treatment of plasma before LA testing in patients on an anticoagulant, then our recommendations have largely been outlined in one of our past papers: Favaloro EJ, Pasalic L. Lupus anticoagulant testing during anticoagulation, including direct oral anticoagulants Res Pract Thromb Haemost. 2022 Mar 15;6(2):e12676. doi: 10.1002/rth2.12676. PMID: 35316943; PMCID: PMC8922544. If you mean treatment of samples for processing for LA testing, then we would follow the ISTH SSC guidance: Devreese KMJ, Bertolaccini ML, Branch DW, de Laat B, Erkan D, Favaloro EJ, Pengo V, Ortel TL, Wahl D, Cohen H. An update on laboratory detection and interpretation of antiphospholipid antibodies for diagnosis of antiphospholipid syndrome: Guidance from the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee (ISTH-SSC) Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies. J Thromb Haemost. 2025 Feb;23(2):731-744. doi: 10.1016/j.jtha.2024.10.022. PMID: 39510414; Devreese KMJ, de Groot PG, de Laat B, Erkan D, Favaloro EJ, Mackie I, Martinuzzo M, Ortel TL, Pengo V, Rand JH, Tripodi A, Wahl D, Cohen H. Guidance from the Scientific and Standardization Committee for lupus anticoagulant/antiphospholipid antibodies of the International Society on Thrombosis and Haemostasis: Update of the guidelines for lupus anticoagulant detection and interpretation. J Thromb Haemost. 2020 Nov;18(11):2828-2839. doi: 10.1111/jth.15047. PMID: 33462974.