The effect of DOAC-Stop on lupus anticoagulant testing in plasma samples of venous thromboembolism patients receiving direct oral anticoagulants
-
Michał Ząbczyk
,
Magdalena Kopytek
Abstract
Background
Direct oral anticoagulants (DOACs) cause false positive lupus anticoagulant (LA) results. We assessed the impact of DOAC-Stop, reversing in vitro effects of DOACs, on LA testing in anticoagulated patients.
Methods
We assessed 75 venous thromboembolism patients aged 44.5±14.6 years. Blood samples were collected 2–28 h since intake of DOACs, including 50 patients on rivaroxaban, 20 on dabigatran and five on apixaban. LA testing was performed at baseline and after DOAC-Stop treatment. Positive LA was defined as the normalized (patient/standard plasma clotting time) LA screening and screening (LA1)/confirmation (LA2) ratios exceeding 1.2.
Results
LA diluted Russell’s viper venom time (dRVVT) normalized screening test revealed abnormal results in 73 (97.3%) and activated partial thromboplastin time (APTT)-LA in 49 (65.3%) patients. In six (8%) patients, antiphospholipid syndrome (APS) was diagnosed. dRVVT LA1/LA2 was abnormal in 35 (50.7%) patients taking DOACs. The APTT ratio was normal in all studied subjects. DOAC-Stop completely removed dabigatran and reduced by 98% rivaroxaban and by 92.3% apixaban concentrations (all p<0.05). After DOAC-Stop screening dRVVT remained prolonged in 34 (49.3%) patients (p<0.001), while dRVVT LA1/LA2 was abnormal in six (8.7%) subjects, with no association with DOAC concentrations at baseline and after DOAC-Stop. The APTT-LA screening test remained prolonged in five (7.2%) patients, while the APTT LA1/LA2 ratio was normal in those subjects. DOAC-Stop did not influence LA testing in APS patients.
Conclusions
Application of DOAC-Stop effectively reduced plasma DOAC concentrations leading to appropriate dRVVT results in up to 97% of VTE patients.
Funding source: Jagiellonian University Medical College
Award Identifier / Grant number: K/ZDS/007717
Funding statement: This work was supported by the Jagiellonian University Medical College (Funder id: 10.13039/100009045, grant number K/ZDS/007717, to A.U.).
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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©2019 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
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- Reference Values and Biological Variations
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- Prognostic value of involved/uninvolved free light chain ratio determined by Freelite and N Latex FLC assays for identification of high-risk smoldering myeloma patients
- Cardiovascular Diseases
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- Evaluation of procalcitonin immunoassay concordance near clinical decision points
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- Differences in procalcitonin measurements between three BRAHMS-partnered immunoassays (Liaison, Elecsys and Architect)
- The short story of the long-term Sigma metric: shift cannot be treated as a linear parameter
- Analytical and diagnostic performance evaluation of five creatinine POCT devices in the identification of patients at risk for post-contrast acute kidney injury (PCAKI)
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Artikel in diesem Heft
- Frontmatter
- Editorial
- Sepsis biomarkers: past, present and future
- Reviews
- Making new biomarkers a reality: the case of serum human epididymis protein 4
- Faecal calprotectin in inflammatory bowel diseases: a review focused on meta-analyses and routine usage limitations
- Opinion Paper
- Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use
- EFLM Paper
- Practice in financial support of third party organised conferences and courses at a national level for health care professionals in Europe
- General Clinical Chemistry and Laboratory Medicine
- Design and implementation of quality control plans that integrate moving average and internal quality control: incorporating the best of both worlds
- Elecsys® and Kryptor immunoassays for the measurement of sFlt-1 and PlGF to aid preeclampsia diagnosis: are they comparable?
- Accuracy assessment of consecutive test strip lots for whole blood INR point-of-care instruments: clarifying the role of frozen plasma pools
- Subcutaneous adipose tissue distribution and telomere length
- Hematology and Coagulation
- Automated measurement of the erythrocyte sedimentation rate: method validation and comparison
- The effect of DOAC-Stop on lupus anticoagulant testing in plasma samples of venous thromboembolism patients receiving direct oral anticoagulants
- Reference Values and Biological Variations
- Narrowed reference intervals for complete blood count in a multiethnic population
- Elucidation of stability profiles of common chemistry analytes in serum stored at six graded temperatures
- Cancer Diagnostics
- Prognostic value of involved/uninvolved free light chain ratio determined by Freelite and N Latex FLC assays for identification of high-risk smoldering myeloma patients
- Cardiovascular Diseases
- Design of a study to investigate the mechanisms of obstructive sleep apnoea by means of drug-induced sleep endoscopy
- Infectious Diseases
- Evaluation of procalcitonin immunoassay concordance near clinical decision points
- Biomarker-assisted identification of sepsis-related acute liver impairment: a frequent and deadly condition in critically ill patients
- Letters to the Editor
- Differences in procalcitonin measurements between three BRAHMS-partnered immunoassays (Liaison, Elecsys and Architect)
- The short story of the long-term Sigma metric: shift cannot be treated as a linear parameter
- Analytical and diagnostic performance evaluation of five creatinine POCT devices in the identification of patients at risk for post-contrast acute kidney injury (PCAKI)
- Lesson from inappropriate TSH-receptor antibody measurement in hypothyroidism: case series and literature review
- Instrument dependent erroneous sodium measurements in hypoproteinemic critically ill patients are causing significant misclassification of dysnatremias
- Inherited bisalbuminemia with growth hormone deficiency
- The first report showing de novo partial 21q monosomy in an adult woman with occult primary ovarian insufficiency (POI)
- Reverse-hybridization resolves a rare HFE genotype untypable by real-time PCR and melting curve analysis in a patient with hyperferritinemia and alcoholic liver disease
- Practical problems when incorporating rapidly changing microbial taxonomy into clinical practice
- Congress Abstracts
- SGKC/SSCC Annual Assembly 2019 28th-30th August 2019 Technopark, Zurich or Evidence Based Laboratory Medicine
