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APCR-Activated Protein C Resistance

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Report in 120Hrs

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No Fasting Required

Details

Coagulation assay to assess resistance to activated protein C.

₹5,062₹7,231

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APCR-Activated Protein C Resistance Test Guide

  • Why is it done?
    • The APCR test measures the resistance of blood to the anticoagulant effect of activated protein C (APC), primarily used to detect Factor V Leiden mutation, the most common inherited thrombophilia
    • Ordered to evaluate patients with unexplained venous thromboembolism (DVT or PE), including first occurrence or recurrent episodes
    • Performed in patients with thrombosis at unusual sites (cerebral or mesenteric veins) or at a young age
    • Used to screen family members of patients with known Factor V Leiden mutation
    • Indicated in women before starting oral contraceptives or hormone replacement therapy if there is a personal or family history of thrombosis
    • Recommended for evaluation of recurrent pregnancy losses or complications such as preeclampsia
  • Normal Range
    • APCR Ratio (Normal): Greater than 2.0 (typically 2.0-4.0)
    • APCR Ratio (Borderline): 1.5-2.0 - suggests possible heterozygous Factor V Leiden
    • APCR Ratio (Abnormal): Less than 1.5 - indicates activated protein C resistance, consistent with Factor V Leiden mutation
    • Unit of Measurement: Ratio (dimensionless)
    • Normal Result: Blood responds appropriately to activated protein C and exhibits normal anticoagulant response, indicating absence of Factor V Leiden
    • Abnormal Result: Blood shows resistance to activated protein C, suggesting Factor V Leiden mutation and increased thrombotic risk
  • Interpretation
    • APCR Ratio > 2.0 (Normal): Indicates normal protein C response; blood clots appropriately and no Factor V Leiden mutation is present; low risk for thrombosis related to this factor
    • APCR Ratio 1.5-2.0 (Borderline): May suggest heterozygous Factor V Leiden mutation; genetic testing recommended to confirm; moderate increase in thrombotic risk
    • APCR Ratio < 1.5 (Abnormal): Strongly suggests Factor V Leiden mutation; significantly increased risk of venous thromboembolism; requires confirmatory DNA testing and anticoagulation management
    • Factors Affecting Results:
    • Anticoagulation therapy (warfarin, heparin) - can affect results and should be withheld if possible
    • Protein C deficiency can cause false positive results (low APCR ratio) independent of Factor V Leiden
    • Lupus anticoagulant presence may interfere with test interpretation
    • Elevated factor VIII levels can lower APCR ratio without representing true resistance
    • Acute thrombosis or pregnancy may temporarily affect results
    • Clinical Significance:
    • Approximately 4-7% of Caucasian population carries Factor V Leiden; higher in specific ethnic groups
    • Homozygous carriers have 50-100 fold increased thrombotic risk; heterozygous carriers have 3-5 fold increased risk
    • Combined with other risk factors (oral contraceptives, pregnancy, immobility), thrombotic risk is significantly amplified
  • Associated Organs
    • Primary Organ Systems:
    • Vascular system - entire circulatory network including arteries and veins
    • Blood and coagulation cascade - particularly affecting factor V and protein C regulation
    • Conditions Associated with Abnormal Results:
    • Deep vein thrombosis (DVT) - lower extremity or other locations
    • Pulmonary embolism (PE) - potentially fatal complications
    • Cerebral venous sinus thrombosis - stroke-like symptoms
    • Mesenteric vein thrombosis - abdominal complications
    • Portal vein thrombosis - liver complications
    • Pregnancy-related complications including preeclampsia and placental insufficiency
    • Potential Complications with Abnormal Results:
    • Recurrent thrombosis requiring lifelong anticoagulation
    • Post-thrombotic syndrome with chronic leg swelling and pain
    • Chronic pulmonary hypertension following pulmonary embolism
    • Hemorrhagic complications from prolonged anticoagulation therapy
    • Increased miscarriage risk and fetal complications in pregnant women
  • Follow-up Tests
    • Confirmatory Testing:
    • Factor V Leiden DNA mutation testing - gold standard genetic confirmation of Factor V Leiden mutation
    • Prothrombin G20210A mutation analysis - evaluates another common inherited thrombophilia
    • Additional Thrombophilia Workup:
    • Protein C activity level - assess protein C deficiency as alternative explanation
    • Protein S activity level - evaluate for protein S deficiency
    • Antithrombin activity - screen for antithrombin deficiency
    • Lupus anticoagulant testing - detect antiphospholipid syndrome
    • Anticardiolipin antibodies and beta-2 glycoprotein I antibodies - additional antiphospholipid testing
    • Imaging and Clinical Studies:
    • Deep vein thrombosis ultrasound - visualize blood clots in veins if thrombosis suspected
    • Computed tomography pulmonary angiography (CTPA) - confirm pulmonary embolism diagnosis
    • Coagulation Studies:
    • Prothrombin time (PT) and international normalized ratio (INR) - baseline and monitoring on warfarin
    • Activated partial thromboplastin time (aPTT) - assess overall coagulation and heparin effect
    • Factor VIII activity level - elevated levels can affect APCR interpretation
    • Monitoring Frequency:
    • INR monitoring on warfarin - initially weekly, then monthly once stable, target INR 2-3
    • Direct oral anticoagulant (DOAC) monitoring - baseline renal function and CBC; repeat annually or as clinically indicated
    • Heparin therapy - aPTT monitoring per protocol, typically every 6 hours initially
  • Fasting Required?
    • Fasting Status: No
    • Fasting is NOT required for APCR testing
    • Special Instructions and Patient Preparation:
    • Avoid anticoagulation therapy if possible before testing - discuss with physician regarding warfarin, heparin, and direct oral anticoagulants; if already on therapy, result interpretation requires adjustment
    • Avoid estrogen-containing medications - oral contraceptives and hormone replacement therapy should be withheld 4-6 weeks if possible, as they affect protein C levels
    • Optimal timing - defer testing for at least 10 days after acute thrombotic event if possible, and 2-4 weeks after thrombosis resolution for most accurate results
    • Avoid recent surgery or immobilization - wait at least 2 weeks after surgical procedures if possible
    • Proper specimen collection - blood sample should be collected in sterile citrate tube; proper fill volume critical as ratio of blood to anticoagulant affects results
    • Notify phlebotomist of relevant medical history - recent blood clots, pregnancy, or current medications that may affect results
    • Specimen handling - transport sample promptly to laboratory; avoid hemolysis or prolonged delays that may compromise test accuracy
    • No specific dietary or activity restrictions the day of testing beyond medication considerations mentioned above

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