Favresse Julien, Lardinois Benjamin, Sabor Lina, Devalet Bérangère, Vandepapeliere Julie, Braibant Maximilien, Lessire Sarah, Chatelain Bernard, Jacqmin Hugues, Douxfils Jonathan, Mullier François
Université Catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Hemostasis Center, NARILIS, Yvoir, Belgium.
Department of Hematology, CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Université Catholique de Louvain, Yvoir, Belgium.
TH Open. 2018 Jun 1;2(2):e202-e209. doi: 10.1055/s-0038-1657785. eCollection 2018 Apr.
The impact of direct oral anticoagulants (DOACs) on laboratory assays used for thrombophilia testing (e.g., antithrombin, protein S, protein C, lupus anticoagulant and activated protein-C resistance) is a well-known issue and may cause false-positive and -negative results. Therefore, the correct interpretation of tests that are performed in patients taking DOACs is mandatory to prevent misclassification and the subsequent clinical consequences. We aimed at evaluating the efficiency of a new and simple procedure (DOAC-Stop®; Haematex Research, Hornsby, Australia) to overcome the effect of all DOACs in real-life settings and to assess the percentage of erroneous results due to the presence of DOACs on thrombophilia screening tests. For this purpose, 135 DOAC-treated patients (38 apixaban, 40 dabigatran, 15 edoxaban, and 42 rivaroxaban) and 20 control patients were enrolled. A significant drop in apixaban, dabigatran, edoxaban, and rivaroxaban plasma concentrations following the DOAC-Stop® treatment was observed (74.8-8.2 ng/mL [ < 0.0001], 95.9-4.7 ng/mL [ < 0.0001], 102.1-8.8 ng/mL [ = 0.001], and 111.3-7.0 ng/mL [ < 0.0001], respectively). The DOAC-Stop® treatment was mostly effective to overcome the effect of DOACs on PTT-LA, dilute Russell's viper venom time (dRVVT) screen, and dRVVT confirm tests. Using our procedures, false-positive results due to DOACs were observed only with lupus anticoagulant tests (up to 75%) and fell to zero after the DOAC-Stop® procedure, regardless of the DOAC considered. In conclusion, the DOAC-Stop® adsorbent procedure appeared to be an effective and simple way to overcome the interference of DOAC on coagulation tests and should facilitate the interpretation of thrombophilia screening tests in patients taking DOACs.
直接口服抗凝剂（DOACs）对用于血栓形成倾向检测的实验室检测（如抗凝血酶、蛋白S、蛋白C、狼疮抗凝物和活化蛋白C抵抗）的影响是一个众所周知的问题，可能会导致假阳性和假阴性结果。因此，对服用DOACs的患者进行的检测结果进行正确解读对于防止错误分类及随后的临床后果至关重要。我们旨在评估一种新的简单程序（DOAC-Stop®；澳大利亚霍恩斯比的Haematex Research公司）在现实环境中克服所有DOACs影响的效率，并评估由于DOACs存在导致的血栓形成倾向筛查检测错误结果的百分比。为此，招募了135名接受DOAC治疗的患者（38名阿哌沙班、40名达比加群、15名依度沙班和42名利伐沙班）和20名对照患者。观察到DOAC-Stop®治疗后阿哌沙班、达比加群、依度沙班和利伐沙班的血浆浓度显著下降（分别为74.8 - 8.2 ng/mL [ < 0.0001]、95.9 - 4.7 ng/mL [ < 0.0001]、102.1 - 8.8 ng/mL [ = 0.001]和111.3 - 7.0 ng/mL [ < 0.0001]）。DOAC-Stop®治疗在很大程度上有效地克服了DOACs对部分凝血活酶时间-狼疮抗凝物（PTT-LA）、稀释蝰蛇毒时间（dRVVT）筛查和dRVVT确认试验的影响。使用我们的程序，仅在狼疮抗凝物检测中观察到由于DOACs导致的假阳性结果（高达75%），并且在DOAC-Stop®程序后降至零，无论考虑哪种DOAC。总之，DOAC-Stop®吸附程序似乎是克服DOAC对凝血试验干扰的一种有效且简单的方法，应有助于对服用DOACs患者的血栓形成倾向筛查检测结果进行解读。
