In certain clinical situations, it is necessary to determine whether clinically relevant plasma levels of direct oral anticoagulants (DOACs) are present. We examined whether qualitative testing of DOACs in urine samples can exclude DOAC plasma concentrations of >30 ng/mL. This prospective single centre cohort study included consecutive patients treated with an oral direct factor Xa inhibitor (DXI) (apixaban, n=31, rivaroxaban, n=53) and direct thrombin inhibitor (DTI) (dabigatran, n=44). We aimed to define the negative predictive value (NPV) and other statistical parameters of detecting DXIs and DTIs by DOAC Dipstick at plasma concentrations of >30 ng/mL. We also determined the best-fit threshold plasma levels using chromogenic substrate assays by logistic regression analysis. Between July 2020 and July 2021, 128 eligible patients (mean age 66 years, 55 females) were included into the study. The NPVs and sensitivities for DXI and DTI of DOAC Dipstick were 100% at >30 ng/ml plasma, for specificities 6% and 21% and for positive predictive values 62% and 72%, respectively. All diagnostic statistical tests improved to values between 86% and 100% at best fitting plasma thresholds of >14 ng/mL for DXI and >19 ng/mL for DTI. Visual analysis using the DOAC Dipstick was 100% in agreement with that of the optoeletronic DOASENSE Reader for all three DOACs. DOAC Dipstick testing can reliably exclude the presence of DOACs in urine samples at best fitting thresholds of >14 and >19 ng/mL in plasma. The performance of the DOAC Dipstick at detecting lower DOAC concentrations in plasma requires confirmation.

nervous system (CNS), caused by CTG repeat expansion on the chromosome 19q. In some patients CNS white matter abnormalities are very extensive, with clinical symptoms including mental changes, hypersomnia, stroke-like episodes and seizures. Participants, Materials/Methods: We report two unrelated patients with DM1. Results: One patient, 50-year-old woman, at the time of clinical examination manifested mild temporal and bulbar muscle weakness, slight flexor neck, distal limb weakness, mild intermittent myotonia. She have bilateral cataract, sterility, without cardiac pathology. Elevated CK (274 U/l). Generalized myotonia and myopathic changes in EMG. Skeletal muscle biopsy compatible with myotonic dystrophy. Cerebrospinal fluid (CSF) was normal without immunological activity. The other patient was 37-year-old man. Clinical examination revealed severe temporal, ocular and bulbar muscle weakness, anterior neck and distal limb muscle weakness, mild myotonia as well as the frontal balding, sterility, bilateral cataract, severe myocardiopathy, elevated CK (280 U/l), generalized myotonia and myopathic changes in EMG, muscle biopsy compatible with DM1. CSF was normal. MRI of the brain in two patients: bilateral, multifocal, subcortical white matter changes, paraventricular and in brain steam, hyperintense on T2-weighted and proton density-weighted images. MRI of cervical spinal cord and MRI cerebral angiography were normal. Conclusions: We found definite MRI abnormalities in 2 patients with DM1. The morphology underlying this leucoencephalopathy is unknown. Examination of the CSF gave no evidence of an inflammatory process, excluding multiple sclerosis. These changes are probably with vascular etiology, and they are part from wide spectrum of musltisystemic disorders in DM1.

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