The effect of DOAC‐Stop<sup>®</sup> on several oral and parenteral anticoagulants

Riva, Nicoletta; Vella, Kevin; Hickey, Kieron; Gatt, Peter; Grima, Charlie; Zammit, Daniel; Ageno, Walter; Kitchen, Steve; Makris, Michael; Gatt, Alex

doi:10.1111/ijlh.13487

Cited by 10 publications

(14 citation statements)

References 12 publications

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“…After DS treatment, Jacquemin et al 22 did not find any changes in factors X, VII, and VIII levels in normal plasma, which was confirmed by Platton et al 25 for factor VIII in nonanticoagulated patient samples. In contrast, Riva et al 47 observed a reduction of factors VIII, IX, X, XI, and XII after DS treatment of normal plasma.…”

Section: Discussionmentioning

confidence: 84%

“…A significant increase of PH and VI and a decrease of TTP was seen in LAC-negative samples after filtration. A dose-dependent procoagulant effect was also described for DS and DOAC-Remove by several studies using TG obtaining increased results for PH and VI and a decreasing LT. 32,33,47 In the studies of Monteyne et al 32 and Riva et al 47 also, a significant increase in ETP and a slight shortening in LT was seen for both DS and DOAC-Remove. A small but significant reduction in free TFPI was considered as the cause of the procoagulant effect after DS or DOAC-Remove treatment.…”

Section: Many Different Strategies Have Been Proposed To Eliminatementioning

confidence: 91%

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Direct Oral Anticoagulant removal by a DOAC filter: Impact on lupus anticoagulant testing – Evaluation on spiked and patient samples

Linskens

Kesel

Devreese

2022

Research and Practice in Thrombosis and Haemostasis

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Background DOAC Filter (DF) is a new device to overcome interference in lupus anticoagulant (LAC) testing by direct oral anticoagulants (DOACs). Objectives We evaluated DOAC removal from plasma and elimination of DOAC interference in LAC testing by DF, and impact of DF on LAC assays in a representative patient cohort, including a comparison with DOAC‐Stop (DS). Methods Normal pooled plasma (NPP) was spiked with increasing concentrations of apixaban, rivaroxaban, edoxaban, and dabigatran. DOAC and LAC was measured on untreated, DF‐treated, and DS‐treated spiked samples. Coagulation parameters and thrombin generation were measured on patient samples (n = 20) before and after DF. Patients treated with DOAC, vitamin K antagonist, or heparin and nonanticoagulated patient samples (n = 139) were tested for LAC before and after DF. Results In spiked NPP, levels were below the lower limit of quantification (LLoQ) after DF/DS treatment for all DOAC concentrations. Following DF, levels were below LLoQ for 53 of 56 DOAC‐containing patient samples. Twenty‐eight of 33 LAC‐positive DOAC‐containing samples became negative after filtration, whereas 5 remained LAC‐positive (1/5 from a patient with antiphospholipid syndrome [APS]). Four LAC‐positive DOAC‐containing samples (from patients without APS), became negative after filtration, whereas they remained LAC positive after DS. In the non‐DOAC patient groups following DF, LAC changed from positive to negative in 8 (due to a procoagulant effect) and vice versa in 2 cases. Conclusion DF reduces DOAC interference in LAC testing. As incomplete DOAC removal may occur, DOAC measurements should be performed after filtration. A procoagulant effect after filtration may lead to erroneous LAC results in non–DOAC‐containing samples. Therefore, using DF should be restricted to DOAC‐containing samples.

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Section: Discussionmentioning

confidence: 84%

Section: Many Different Strategies Have Been Proposed To Eliminatementioning

confidence: 91%

Direct Oral Anticoagulant removal by a DOAC filter: Impact on lupus anticoagulant testing – Evaluation on spiked and patient samples

Linskens

Kesel

Devreese

2022

Research and Practice in Thrombosis and Haemostasis

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“…Because of the increased necessity of testing patients for LA while on DOAC, several publications have emerged that have suggested the use of an insoluble adsorbent material to eliminate DOACs in vitro. 68,[70][71][72] This DOAC-Stop reagent can be added to samples before testing, and it will not affect screening tests like dRVVT in patients not receiving DOACs. Another potential way to overcome and eliminate the interfering effect of DOACs would be to use a simple charcoal product.…”

Section: Evaluating La Results In Anticoagulated Patientsmentioning

confidence: 99%

Laboratory Approaches to Test the Function of Antiphospholipid Antibodies

Szabó

Antal‐Szalmás

Kerényi

et al. 2021

Semin Thromb Hemost

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Antiphospholipid syndrome (APS) is a systemic autoimmune disorder caused by the presence of aPLs (antiphospholipid antibodies, i.e., anti-β2-glycoprotein I and anti-cardiolipin). Everyday practice in terms of laboratory diagnostics of APS includes determination of aPLs and well-known functional assays assessing for lupus anticoagulant (LA), in turn using various tests. According to recent guidelines, the recommended method for LA identification or exclusion is based on the Russell Viper Venom test and a sensitive activated partial thromboplastin time assay. Despite the fact that LA can be quantified in laboratory practice in this way, LA is still used as a binary parameter that is just one of the risk factors of thrombosis in APS. As of today, there are no other functional assays to routinely assess the risk of thrombosis in APS. It is well-known that APS patients display a wide range of clinical outcomes although they may express very similar laboratory findings. One way to solve this dilemma, could be if antibodies could be further delineated using more advanced functional tests. Therefore, we review the diagnostic approaches to test the function of aPLs. We further discuss how thrombin generation assays, and rotational thromboelastometry tests can be influenced by LA, and how experimental methods, such as flow cytometric platelet activation, surface plasmon resonance, or nano differential scanning fluorimetry can bring us closer to the puzzling interaction of aPLs with platelets as well as with their soluble protein ligand. These novel approaches may eventually enable better characterization of aPL, and also provide a better linkage to APS pathophysiology.

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“…However, this strategy has lost favor in the revised 2020 ISTH LA guidelines 5,17 (Table 2; Table S1) because some experts believe this may lead to false-negative or false-positive LA findings. Nevertheless, it may re- [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] (Table 3; Table S2). The product represents a form of activated charcoal, and one pellet of the commercial product can remove a therapeutic level of all the DOACs (dabigatran, rivaroxaban, and apixaban being those most well studied) from 1 ml of citrate anticoagulated plasma.…”

Section: Ta B L E 2 (Continued)mentioning

confidence: 99%

Lupus anticoagulant testing during anticoagulation, including direct oral anticoagulants

Favaloro

Pasalic

2022

Research and Practice in Thrombosis and Haemostasis

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Background Lupus anticoagulants (LA) are one laboratory criterion for classification of antiphospholipid syndrome, with presence of vascular thrombosis and/or pregnancy/fetal morbidity being clinical criteria. The presence of LA is detected (or excluded) by laboratory testing, with the activated partial thromboplastin time and dilute Russell's viper venom time the most commonly used tests. Given the association of thrombosis with LA, it is no surprise that anticoagulants are used to treat or manage such patients. Objectives To review and discuss interferences from anticoagulants on LA testing, and strategies to mitigate these. Methods This narrative review assessed interference from commonly used anticoagulants, focusing on LA testing while on direct oral anticoagulants (DOACs), including use of DOAC neutralizers. Results The classical anticoagulants comprise vitamin K antagonists such as warfarin, and heparins, predominantly unfractionated heparin and low molecular weight heparin (LMWH). DOACs have emerged with favorable efficacy and safety. These comprise two classes: direct anti‐thrombin (anti‐IIa; dabigatran) or direct anti‐Xa (rivaroxaban, apixaban, edoxaban) agents. All anticoagulants affect clotting assays, although there are differences in effects according to anticoagulant and assay. Nevertheless, because of such interferences, anticoagulants can lead to false‐negative or false‐positive LA findings. Several strategies can mitigate such interferences, including avoidance of testing while patients are on such anticoagulants, temporarily switching to an anticoagulant (i.e., LMWH) with less assay interference, testing for LA at nadir levels of anticoagulants, and/or use of anticoagulant neutralizers. Conclusion Whilst the best approach is to avoid LA testing on patients taking anticoagulants; if unavoidable, testing may be facilitated by various mitigating strategies.

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The effect of DOAC‐Stop^® on several oral and parenteral anticoagulants

Cited by 10 publications

References 12 publications

Direct Oral Anticoagulant removal by a DOAC filter: Impact on lupus anticoagulant testing – Evaluation on spiked and patient samples

Direct Oral Anticoagulant removal by a DOAC filter: Impact on lupus anticoagulant testing – Evaluation on spiked and patient samples

Laboratory Approaches to Test the Function of Antiphospholipid Antibodies

Lupus anticoagulant testing during anticoagulation, including direct oral anticoagulants

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The effect of DOAC‐Stop® on several oral and parenteral anticoagulants

Cited by 10 publications

References 12 publications

Direct Oral Anticoagulant removal by a DOAC filter: Impact on lupus anticoagulant testing – Evaluation on spiked and patient samples

Direct Oral Anticoagulant removal by a DOAC filter: Impact on lupus anticoagulant testing – Evaluation on spiked and patient samples

Laboratory Approaches to Test the Function of Antiphospholipid Antibodies

Lupus anticoagulant testing during anticoagulation, including direct oral anticoagulants

Contact Info

Product

Resources

About

The effect of DOAC‐Stop^® on several oral and parenteral anticoagulants