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.
Clin Chem Lab Med. 2019 Aug 27;57(9):1374-1381. doi: 10.1515/cclm-2018-1197.
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.
直接口服抗凝剂（DOACs）可导致狼疮抗凝物（LA）检测出现假阳性结果。我们评估了 DOAC-Stop（一种逆转 DOACs 体外作用的药物）对接受抗凝治疗的患者的 LA 检测的影响。
我们评估了 75 例年龄为 44.5±14.6 岁的静脉血栓栓塞症患者。采集血液样本的时间距离 DOACs 服药后 2-28 小时，包括 50 例服用利伐沙班、20 例服用达比加群和 5 例服用阿哌沙班的患者。在基线和 DOAC-Stop 治疗后进行 LA 检测。LA 稀释 Russell 蝰蛇毒时间（dRVVT）正常筛查试验结果异常的定义为：患者/标准血浆凝固时间的比值超过 1.2 的 LA 筛查和筛查（LA1）/确认（LA2）比值。
73 例（97.3%）患者的 dRVVT 正常筛查试验结果异常，49 例（65.3%）患者的活化部分凝血活酶时间（APTT）-LA 试验结果异常。6 例（8%）患者被诊断为抗磷脂综合征（APS）。服用 DOACs 的 35 例（50.7%）患者的 dRVVT LA1/LA2 比值异常。所有研究对象的 APTT 比值均正常。DOAC-Stop 可完全清除达比加群，并使利伐沙班的浓度降低 98%，阿哌沙班的浓度降低 92.3%（均 p<0.05）。DOAC-Stop 治疗后，34 例（49.3%）患者的 dRVVT 仍延长（p<0.001），6 例（8.7%）患者的 dRVVT LA1/LA2 比值异常，与基线和 DOAC-Stop 后 DOAC 浓度无关。5 例（7.2%）患者的 APTT-LA 筛查试验仍延长，而这些患者的 APTT LA1/LA2 比值正常。DOAC-Stop 不影响 APS 患者的 LA 检测。
应用 DOAC-Stop 可有效降低血浆 DOAC 浓度，使高达 97%的 VTE 患者的 dRVVT 结果恢复正常。
