{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:54:17Z","timestamp":1782496457303,"version":"3.54.5"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Development Fund, Faculty of Medicine Siriraj Hospital, Mahidol University","award":["R016631006"],"award-info":[{"award-number":["R016631006"]}]},{"name":"Chalermphrakiat Grant"},{"name":"Chalermphrakiat Grant"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Lupus anticoagulants (LA) are heterogeneous antiphospholipid antibodies that interfere with phospholipid-dependent coagulation assays, resulting in considerable variability among detection methods. Although international guidelines recommend a stepwise approach incorporating screening, mixing, and confirmatory testing, integrated strategies omitting routine mixing studies are widely used. Different percentile-based cutoffs have been proposed for defining LA positivity.We retrospectively analyzed 135 citrated plasma samples requested for LA testing. Five LA detection approaches were evaluated: 4 integrated assays and 1 activated partial thromboplastin time (APTT)\u2013based approach following the ISTH-recommended stepwise algorithm with a mixing study. The integrated assays comprised silica clotting time, dilute Russell viper venom time (dRVVT) using 2 different reagent systems, and an APTT-based assay. Precision studies and reference intervals were established, and LA positivity rates were compared using 97.5th and 99th percentile cutoffs. Inter-assay agreement and associations with anticardiolipin (aCL) and anti\u2013\u03b22-glycoprotein I (a\u03b22GPI) antiphospholipid antibodies were assessed. LA positivity rates varied across procedures (19.3%\u201335.6%) at the 97.5th percentile. Application of the 99th percentile decreased positivity for dRVVT-HemosIL and APTT-based assays. Positivity increased at the 97.5th percentile in patients tested according to ISTH indications, with minimal impact in noncompliant cases. Inter-assay agreement ranged from fair to substantial and was influenced by assay type and cutoff definition. APTT-based assays showed the strongest associations with aCL and a\u03b22GPI antibodies. LA detection is strongly influenced by assay selection and cutoff strategy. Positivity rate\u2013based evaluation provides a practical framework for comparing LA assays in laboratory practice, particularly in the absence of a reference standard.<\/jats:p>","DOI":"10.1371\/journal.pone.0352430","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:34:28Z","timestamp":1782495268000},"page":"e0352430","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of two algorithms of APTT-based lupus anticoagulant assay, two Dilute Russell viper venom time reagents, and silica clotting time"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4660-3961","authenticated-orcid":true,"given":"Preechaya","family":"Wongkrajang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titiwan","family":"Pientong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ratchaneekorn","family":"Hanyongyuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panutsaya","family":"Tientadakul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"issue":"1","key":"pone.0352430.ref001","doi-asserted-by":"crossref","first-page":"102333","DOI":"10.1016\/j.rpth.2024.102333","article-title":"Comparison of different algorithms for lupus anticoagulant detection: a single-center experience","volume":"8","author":"D Apipongrat","year":"2024","journal-title":"Res Pract Thromb Haemost"},{"issue":"7","key":"pone.0352430.ref002","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1055\/a-1701-2809","article-title":"Pathophysiology of Antiphospholipid Syndrome","volume":"122","author":"D Green","year":"2022","journal-title":"Thromb Haemost"},{"issue":"9","key":"pone.0352430.ref003","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1002\/art.40930","article-title":"2019 European League Against Rheumatism\/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus","volume":"71","author":"M Aringer","year":"2019","journal-title":"Arthritis Rheumatol"},{"issue":"10","key":"pone.0352430.ref004","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1002\/art.42624","article-title":"The 2023 ACR\/EULAR Antiphospholipid Syndrome Classification Criteria","volume":"75","author":"M Barbhaiya","year":"2023","journal-title":"Arthritis Rheumatol"},{"key":"pone.0352430.ref005","doi-asserted-by":"crossref","DOI":"10.1016\/S0049-3848(09)70002-7","article-title":"Pathogenesis and management of antiphospholipid syndrome","volume":"123","author":"M Greaves","year":"2009","journal-title":"Thromb Res"},{"issue":"4","key":"pone.0352430.ref006","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1055\/s-0032-1304717","article-title":"To mix or not to mix in lupus anticoagulant testing? That is the question","volume":"38","author":"A Tripodi","year":"2012","journal-title":"Semin Thromb Hemost"},{"key":"pone.0352430.ref007","doi-asserted-by":"crossref","first-page":"10760296241306751","DOI":"10.1177\/10760296241306751","article-title":"Key Issues at the Forefront of Diagnosis and Testing for Antiphospholipid Syndrome","volume":"30","author":"J Qiao","year":"2024","journal-title":"Clin Appl Thromb Hemost"},{"key":"pone.0352430.ref008","unstructured":"Clinical and Laboratory Standards Institute. Laboratory testing for the lupus anticoagulant; approved guideline. Wayne, PA: Clinical and Laboratory Standards Institute. 2014."},{"issue":"10","key":"pone.0352430.ref009","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1111\/j.1538-7836.2009.03555.x","article-title":"Update of the guidelines for lupus anticoagulant detection","volume":"7","author":"V Pengo","year":"2009","journal-title":"Journal of Thrombosis and Haemostasis"},{"issue":"11","key":"pone.0352430.ref010","doi-asserted-by":"crossref","first-page":"2828","DOI":"10.1111\/jth.15047","article-title":"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","volume":"18","author":"KMJ Devreese","year":"2020","journal-title":"J Thromb Haemost"},{"issue":"6","key":"pone.0352430.ref011","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1055\/s-0042-1744363","article-title":"Testing for Lupus Anticoagulants","volume":"48","author":"GW Moore","year":"2022","journal-title":"Semin Thromb Hemost"},{"issue":"2","key":"pone.0352430.ref012","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1538-7836.2006.01753.x","article-title":"International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)","volume":"4","author":"S Miyakis","year":"2006","journal-title":"J Thromb Haemost"},{"key":"pone.0352430.ref013","unstructured":"Clinical and Laboratory Standards Institute. User verification of precision and estimation of bias; approved guideline third edition. Wayne, PA: Clinical and Laboratory Standards Institute. 2014."},{"key":"pone.0352430.ref014","unstructured":"Innovations D. Allowable total error table. https:\/\/datainnovations.com\/allowable-total-error-table. Accessed 2026 January 16."},{"issue":"6","key":"pone.0352430.ref015","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1111\/ijlh.13102","article-title":"Impact of different preanalytical conditions on results of lupus anticoagulant tests","volume":"41","author":"AH Kristoffersen","year":"2019","journal-title":"Int J Lab Hematol"},{"key":"pone.0352430.ref016","doi-asserted-by":"crossref","DOI":"10.1093\/clinchem\/hvaf086.142","article-title":"A-146 Classic vs. Integrated Testing Algorithms for Lupus Anticoagulant: How to Proceed?","volume":"71","author":"N Lickteig","year":"2025","journal-title":"Clinical Chemistry"},{"issue":"2","key":"pone.0352430.ref017","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1002\/art.43341","article-title":"Prognostic Value of Lupus Anticoagulant and Anti-\u03b22 Glycoprotein I Antibody in Adverse Pregnancy Outcomes","volume":"78","author":"M Nonobe","year":"2026","journal-title":"Arthritis Rheumatol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0352430","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:34:34Z","timestamp":1782495274000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0352430"}},"subtitle":[],"editor":[{"given":"Ufuk","family":"Demirci","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":17,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0352430","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]}}}