Can lupus anticoagulant be positive in someone taking Eliquis (apixaban)?

From the Guidelines

Yes, lupus anticoagulant can be positive in someone taking Eliquis (apixaban), and this is a critical consideration in patients with antiphospholipid syndrome (APS) or those at risk for arterial thrombosis. According to the most recent guidelines, patients with APS, especially those who are "triple-positive" for lupus anticoagulant, anti-cardiolipin, and anti-b2-glycoprotein-I antibodies, should avoid direct oral anticoagulants (DOACs) like Eliquis due to the potential for increased thrombotic risk 1. Instead, vitamin K antagonists (VKAs) are recommended as first-line therapy for these patients. The interference of Eliquis with laboratory tests for lupus anticoagulant is a significant concern, as it can lead to false-positive results due to its mechanism of action inhibiting factor Xa in the coagulation cascade.

• Key considerations include:
  • The potential for false-positive lupus anticoagulant results in patients taking Eliquis
  • The need to temporarily discontinue Eliquis for at least 48 hours before lupus anticoagulant testing, if medically safe, to avoid interference with test results
  • The importance of informing the laboratory about Eliquis use to ensure proper interpretation of results
  • The recommendation to use VKAs over DOACs in patients with APS or at high risk for arterial thrombosis, as suggested by the Chest guideline and expert panel report 1.
• In clinical practice, managing patients on Eliquis who require lupus anticoagulant testing involves careful consideration of the risks and benefits of temporarily discontinuing anticoagulation therapy, and alternative testing strategies may be employed to minimize these risks.

From the FDA Drug Label

5.6 Increased Risk of Thrombosis in Patients with Triple Positive Antiphospholipid Syndrome Direct-acting oral anticoagulants (DOACs), including Apixaban Tablets, are not recommended for use in patients with triple-positive antiphospholipid syndrome (APS) For patients with APS (especially those who are triple positive [positive for lupus anticoagulant, anticardioplipin, and anti-beta 2-glycoprotein I antibodies]), treatment with DOACs has been associated with increased rates of recurrent thrombotic events compared with vitamin K antagonist therapy

The presence of lupus anticoagulant can be an indicator of antiphospholipid syndrome (APS). Since apixaban is a direct-acting oral anticoagulant (DOAC), it is not recommended for use in patients with triple-positive APS, which includes those positive for lupus anticoagulant. However, this does not directly answer whether lupus anticoagulant can be positive in someone taking Eliquis (apixaban). Lupus anticoagulant is an antibody that can be present in patients, and its presence is not directly caused by apixaban. Therefore, it is possible for a patient taking apixaban to have a positive test for lupus anticoagulant if they have an underlying condition that causes the production of this antibody 2.

From the Research

Lupus Anticoagulant and Eliquis

• Lupus anticoagulant (LA) is a marker of thrombophilia, and its testing can be affected by anticoagulant therapy, including direct oral anticoagulants (DOACs) like Eliquis (apixaban) 3, 4, 5, 6.
• Studies have shown that DOACs, including apixaban, can lead to false-positive or false-negative results in LA testing 3, 4, 5.
• The Russell viper venom time (RVVT) assay, commonly used for LA testing, can be affected by DOACs, with rivaroxaban and apixaban causing prolongation of the assay 3, 4.
• A study found that apixaban affected the confirmatory test more than the screen, leading to lower RVVT ratios, which can result in false-negative results 3.
• Another study found that LA testing in patients taking DOACs, including apixaban, led to lower intra-patient consistency in LA test results 3.
• It is recommended to avoid LA testing in patients taking anticoagulants, including DOACs, or to use strategies to mitigate interference, such as testing at nadir levels of anticoagulants or using anticoagulant neutralizers 6.
• A commercially available reagent, DOAC-Stop, has been shown to effectively remove DOAC interference in LA testing, allowing for accurate identification of patients with lupus anticoagulant antibodies 7.

Key Findings

• DOACs, including apixaban, can interfere with LA testing, leading to false-positive or false-negative results.
• The RVVT assay can be affected by DOACs, with rivaroxaban and apixaban causing prolongation of the assay.
• Strategies to mitigate interference, such as testing at nadir levels of anticoagulants or using anticoagulant neutralizers, can be effective in accurate LA testing.
• DOAC-Stop is a commercially available reagent that can effectively remove DOAC interference in LA testing.