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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

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1437-4331
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Volume 57, Issue 9

Issues

The effect of DOAC-Stop on lupus anticoagulant testing in plasma samples of venous thromboembolism patients receiving direct oral anticoagulants

Michał ZąbczykORCID iD: https://orcid.org/0000-0003-1762-308X / Magdalena Kopytek
  • Institute of Cardiology, Jagiellonian University Medical College and John Paul II Hospital, Krakow, Poland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Joanna Natorska
  • Institute of Cardiology, Jagiellonian University Medical College and John Paul II Hospital, Krakow, Poland
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Anetta Undas
  • Corresponding author
  • Institute of Cardiology, Jagiellonian University Medical College and John Paul II Hospital, Krakow, Poland
  • Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland, Phone: +48-12-6143004, Fax: +48-12-6142120
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-02-14 | DOI: https://doi.org/10.1515/cclm-2018-1197

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.

Keywords: antiphospholipid syndrome testing; direct oral anticoagulants (DOAC); DOAC-Stop; lupus anticoagulant

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About the article

Corresponding author: Anetta Undas, MD, PhD, Institute of Cardiology, Jagiellonian University Medical College and John Paul II Hospital, 80 Pradnicka St., 31-202 Krakow, Poland


Received: 2018-11-08

Accepted: 2019-01-07

Published Online: 2019-02-14

Published in Print: 2019-08-27


Funding Source: Jagiellonian University Medical College

Award identifier / Grant number: K/ZDS/007717

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.


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 57, Issue 9, Pages 1374–1381, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2018-1197.

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