Novelli Chiara, Pradella Paola, Papandrea Maria, Montaruli Barbara
Transfusion Center and Haematology Laboratory, ASST Ovest Milanese, Legnano Hospital, Legnano.
Transfusion Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina, University Hospital, Trieste.
Blood Coagul Fibrinolysis. 2023 Apr 1;34(3):199-205. doi: 10.1097/MBC.0000000000001214. Epub 2023 Mar 28.
Direct oral anticoagulants (DOACs) interfere with many coagulation assays, mostly in lupus anticoagulant (LA) detection, causing false positive and negative results. Despite guidelines recommendations, LA testing may be important during anticoagulation when the clinician has to decide whether to prolong or discontinue the drug.
In this study, the effect of activated charcoal (DOAC-Stop, DS) as a DOAC-adsorbent was investigated on samples from DOACs treated and untreated patients.
165 plasma samples with a LA request were collected in three laboratories: 105 were from patients receiving DOACs and 60 were from nonanticoagulated patients with 30 LA negative and 30 LA positive. All coagulation screening assays and LA assays were evaluated before and after DS treatment.
The adsorption technique reduced DOACs concentration below the Lower Limit of Quantification. For nonanticoagulated patients: no significant difference in ratio results of coagulation screening (prothrombin time, activated partial thromboplastin time and thrombin time) and LA tests were observed before and after addition of DS in LA positive and negative patients. Every LA was correctly classified. For anticoagulated patients: a statistically significant difference was found for coagulation screening assays and LA assays. Final LA conclusions changed after DS addition from positive to negative in 58.9% of patients (more frequently with Rivaroxaban) and from negative to positive in 8% of patients (more frequently with Apixaban).
Our study suggests that DOAC-Stop can be used in daily laboratory practice to remove DOACs interference for a more accurate assessment of LA that is essential for diagnosis and management of APS patients.
直接口服抗凝剂（DOACs）会干扰多种凝血检测，主要是在狼疮抗凝物（LA）检测中，导致假阳性和假阴性结果。尽管有指南推荐，但在抗凝治疗期间，当临床医生必须决定是否延长或停用药物时，LA检测可能很重要。
在本研究中，研究了活性炭（DOAC-Stop，DS）作为DOAC吸附剂对DOAC治疗和未治疗患者样本的影响。
在三个实验室收集了165份有LA检测需求的血浆样本：105份来自接受DOAC治疗的患者，60份来自未抗凝患者，其中30份LA阴性，30份LA阳性。在DS处理前后评估所有凝血筛查检测和LA检测。
吸附技术将DOACs浓度降低至定量下限以下。对于未抗凝患者：在LA阳性和阴性患者中，添加DS前后，凝血筛查（凝血酶原时间、活化部分凝血活酶时间和凝血酶时间）和LA检测的比值结果无显著差异。每个LA都被正确分类。对于抗凝患者：凝血筛查检测和LA检测存在统计学显著差异。添加DS后，58.9%的患者（利伐沙班更常见）的最终LA结论从阳性变为阴性，8%的患者（阿哌沙班更常见）从阴性变为阳性。
我们的研究表明，DOAC-Stop可用于日常实验室实践，以消除DOACs的干扰，从而更准确地评估LA，这对于抗磷脂综合征（APS）患者的诊断和管理至关重要。
