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Direct oral anticoagulant adsorption: impact on lupus anticoagulant testing. Review of the literature and evaluation on spiked and patient samples

Published on May 12, 2020in Journal of Thrombosis and Haemostasis4.662
· DOI :10.1111/JTH.14894
Pieter M. De Kesel1
Estimated H-index: 1
(Ghent University Hospital),
Katrien Devreese24
Estimated H-index: 24
(UGent: Ghent University)
Abstract
BACKGROUND: Direct oral anticoagulants (DOAC) interfere with lupus anticoagulant (LAC) testing. DOAC-StopTM (D-S) represents a preanalytical strategy to cope with this issue. OBJECTIVES: To assess D-S's ability to remove DOAC from plasma and overcome DOAC interference in LAC assays and to evaluate D-S's applicability in a representative patient cohort with routine LAC request. METHODS: Apixaban (30-933 ng/ml), edoxaban (31-1060 ng/ml), rivaroxaban (35-1020 ng/ml) and dabigatran (20-360 ng/ml) were spiked to normal plasma. Aliquots were treated with D-S or untreated before DOAC and LAC testing. Patient samples containing DOAC (n=43), vitamin K antagonists (VKA,n=25), heparins (n=21) or no anticoagulants (n=63) were tested for LAC before and after D-S. RESULTS: Spiking experiments revealed false positive LAC from low concentrations of DOAC except apixaban. Following D-S, DOAC levels were below lower limits of quantification (LLoQs), except for apixaban at the highest concentration, and no false positive LAC was obtained. DOAC levels were below LLoQs after D-S in 39/43 DOAC-containing patient samples. For 23/29 LAC-positive DOAC-containing samples, LAC tests became negative after D-S, while 3/6 samples remaining positive were from patients with (high probability for) antiphospholipid syndrome. In the non-DOAC treated groups, LAC changed from positive to negative in 10 and vice versa in 2 cases. CONCLUSIONS: D-S limits DOAC interference in LAC assays. DOAC concentration measurement should be performed in D-S treated samples as incomplete removal may occur. Applying D-S to VKA-containing, heparin-containing or not-anticoagulated samples may lead to erroneous LAC results. Therefore, D-S should only be used in plasma from DOAC-treated patients.
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#2Hannah Cohen (UCL: University College London)H-Index: 40
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INTRODUCTION: Direct oral factor Xa inhibitors (xabans) induce false positive results for lupus anticoagulant (LA) diagnosis. Consequently, it is suggested not to perform LA testing in xabans patients although it may be useful in selected patients. In this monocentric study, we evaluated xabans impact at trough levels (ie, just before the next intake) on LA diagnosis in treated patients using dilute Russell viper venom time (dRVVT) and two LA sensitive activated partial thromboplastin time (aPTT...
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#1Sally Cox‐Morton (Cambridge University Hospitals NHS Foundation Trust)H-Index: 1
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#2Laura Andreoli (University of Brescia)H-Index: 8
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The objective was to develop evidence-based recommendations for the management of antiphospholipid syndrome (APS) in adults. Based on evidence from a systematic literature review and expert opinion, overarching principles and recommendations were formulated and voted. High-risk antiphospholipid antibody (aPL) profile is associated with greater risk for thrombotic and obstetric APS. Risk modification includes screening for and management of cardiovascular and venous thrombosis risk factors, patie...
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: 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. ...
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Abstract Introduction Lupus anticoagulant (LA) investigation in patients on anticoagulant therapy is problematic. Rivaroxaban in particular causes significant interference, prolonging both LA screening and confirmation tests, and falsely raising LA screen/confirm ratios, leading to potential false identification of LA. The Russell Viper Venom Time (RVVT) assay, key to the investigation of LA, is especially sensitive to rivaroxaban. Materials and methods We assessed cross laboratory (n = 82) test...
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