Department of Laboratory Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
J Thromb Haemost. 2019 Aug;17(8):1354-1362. doi: 10.1111/jth.14488. Epub 2019 Jun 12.
Direct oral anticoagulants (DOACs) affect laboratory coagulations tests. Activated carbon (AC) can be used for adsorption of DOACs during acute human intoxications.
This study evaluates whether AC can also be used to resolve DOAC interference on in vitro clotting tests (prothrombin time [PT], activated partial thromboplastin time [aPTT], and lupus anticoagulant [LA] assays).
PATIENTS/METHODS: Interference on PT, aPTT, Liquid anti-FXa, DTI, and LA screening/confirmation (SCT and dRVVT) was determined by spiking citrated plasma from 5 adult controls with 0, 20, 40, 80, 120, or 160 mg/mL AC. DOAC concentrations, PT, and aPTT were compared before and after AC addition to citrated plasma from patients receiving DOACs (n = 29), low molecular weight heparin (n = 10), and coumarin (n = 10) therapy. Samples from 69 LA screened patients were compared before and after AC addition.
A concentration of 20 mg/mL AC had the lowest interference and was selected for further experiments. After AC addition, all DOAC concentrations were below the limit of quantification in the 29 treated patients, except for 2 apixaban samples. AC removed DOAC interference on PT and aPTT but had no impact on results obtained during coumarin or low molecular weight heparin therapy. Of 15 LA samples with interference resulting from DOAC therapy, 14 samples became negative and 1 positive after AC addition. Interference from coumarin therapy was not resolved. All 19 LA negative samples remained negative. AC treatment of the negative pooled plasma was required to avoid false-negative LA results in 21 known LA-positive samples.
AC selectively removes DOAC interference on PT, aPTT, and LA assays.
直接口服抗凝剂（DOACs）会影响实验室凝血检测。活性炭（AC）可用于吸附急性人体中毒时的 DOACs。
本研究旨在评估活性炭是否也可用于解决 DOAC 对体外凝血检测（凝血酶原时间 [PT]、活化部分凝血活酶时间 [aPTT]和狼疮抗凝物 [LA]检测）的干扰。
患者/方法：通过向 5 名成人对照者枸橼酸盐血浆中加入 0、20、40、80、120 或 160mg/mL 的 AC，测定 PT、aPTT、液体抗 FXa、DTI 和 LA 筛选/确认（SCT 和 dRVVT）的干扰。将 DOAC 浓度、PT 和 aPTT 与接受 DOAC（n=29）、低分子肝素（n=10）和华法林（n=10）治疗的患者枸橼酸盐血浆中加入 AC 前后进行比较。比较了 69 例 LA 筛查患者加入 AC 前后的结果。
20mg/mL AC 浓度干扰最小，被选为进一步实验的浓度。加入 AC 后，除 2 个阿哌沙班样本外，所有治疗患者的 DOAC 浓度均低于定量下限。AC 可去除 DOAC 对 PT 和 aPTT 的干扰，但对接受华法林或低分子肝素治疗患者的检测结果无影响。在 15 例因 DOAC 治疗而产生干扰的 LA 样本中，14 例在加入 AC 后变为阴性，1 例仍为阳性。华法林治疗引起的干扰无法消除。在 21 例已知 LA 阳性的样本中，需要 AC 处理阴性混合血浆以避免假阴性 LA 结果。
AC 选择性去除 DOAC 对 PT、aPTT 和 LA 检测的干扰。
