Evaluation of the DOAC-Stop® Procedure to Overcome the Effect of DOACs on Several Thrombophilia Screening Tests.

Journal: TH open : companion journal to thrombosis and haemostasis
Published Date: Jun 1, 2018

Abstract

The impact of direct oral anticoagulants (DOACs) on laboratory assays used for thrombophilia testing (e.g., antithrombin, protein S, protein C, lupus anticoagulant and activated protein-C resistance) is a well-known issue and may cause false-positive and -negative results. Therefore, the correct interpretation of tests that are performed in patients taking DOACs is mandatory to prevent misclassification and the subsequent clinical consequences. We aimed at evaluating the efficiency of a new and simple procedure (DOAC-Stop®; Haematex Research, Hornsby, Australia) to overcome the effect of all DOACs in real-life settings and to assess the percentage of erroneous results due to the presence of DOACs on thrombophilia screening tests. For this purpose, 135 DOAC-treated patients (38 apixaban, 40 dabigatran, 15 edoxaban, and 42 rivaroxaban) and 20 control patients were enrolled. A significant drop in apixaban, dabigatran, edoxaban, and rivaroxaban plasma concentrations following the DOAC-Stop® treatment was observed (74.8-8.2 ng/mL [  < 0.0001], 95.9-4.7 ng/mL [  < 0.0001], 102.1-8.8 ng/mL [  = 0.001], and 111.3-7.0 ng/mL [  < 0.0001], respectively). The DOAC-Stop® treatment was mostly effective to overcome the effect of DOACs on PTT-LA, dilute Russell's viper venom time (dRVVT) screen, and dRVVT confirm tests. Using our procedures, false-positive results due to DOACs were observed only with lupus anticoagulant tests (up to 75%) and fell to zero after the DOAC-Stop® procedure, regardless of the DOAC considered. In conclusion, the DOAC-Stop® adsorbent procedure appeared to be an effective and simple way to overcome the interference of DOAC on coagulation tests and should facilitate the interpretation of thrombophilia screening tests in patients taking DOACs.

Authors

  • Julien Favresse
    Université Catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center, NARILIS, Yvoir, Belgium.
  • Benjamin Lardinois
    Université Catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center, NARILIS, Yvoir, Belgium.
  • Lina Sabor
    Université Catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center, NARILIS, Yvoir, Belgium.
  • Bérangère Devalet
    Department of Hematology, CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Université Catholique de Louvain, Yvoir, Belgium.
  • Julie Vandepapeliere
    Department of Hematology, CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Université Catholique de Louvain, Yvoir, Belgium.
  • Maximilien Braibant
    Department of Pharmacy, CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Université Catholique de Louvain, Yvoir, Belgium.
  • Sarah Lessire
    Department of Anesthesiology, CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Université Catholique de Louvain, Yvoir, Belgium.
  • Bernard Chatelain
    Université Catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center, NARILIS, Yvoir, Belgium.
  • Hugues Jacqmin
    Université Catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center, NARILIS, Yvoir, Belgium.
  • Jonathan Douxfils
    Department of Pharmacy, Namur Thrombosis and Hemostasis Center, Université de Namur, Yvoir, Belgium.
  • François Mullier
    Université Catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center, NARILIS, Yvoir, Belgium.

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