Exner Thomas, Dangol Manita, Favaloro Emmanuel J
Haematex Research Pty Ltd., Sydney, NSW 2077, Australia.
Haematology Department, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Sydney, NSW 2145, Australia.
J Clin Med. 2024 Feb 12;13(4):1042. doi: 10.3390/jcm13041042.
Direct oral anticoagulants (DOACs) cause unwanted interference in various hemostasis assays, including lupus anticoagulant (LA) testing, where false positive and false negative identification may occur. DOAC Stop (DS) is an activated charcoal (AC) product used to specifically and effectively adsorb DOACs from test plasma. This process normally requires plasma treatment, centrifugation and plasma separation prior to tests, but inexperienced operators may also inadvertently transfer residual AC particles, thereby potentially adversely affecting clot detection.
We hypothesized that residual DS might not be problematic for mechanical clot detection. We therefore investigated the potential impact of DS and a new DS liquid (DS-L) product on clotting tests using a mechanical clot detection system. Varying concentrations of DS were added to normal and abnormal plasmas with and without DOAC presence. Clotting tests including PT, APTT and dRVVT were performed directly in the analyzer without plasma/DS centrifugation.
DS up to double the recommended treatment level had only minor effects on all test results, despite completely obscuring visibility in the plasma/reagent mix. This confirms that the centrifugation step may be able to be omitted when using mechanical detection systems.
Should DS carryover into treated plasmas occur, this should not cause issues with testing performed on mechanical clot-sensing devices. Moreover, we hypothesize that DS can be used directly in these systems, without the need for centrifugation, thereby simplifying its many potential applications.
直接口服抗凝剂（DOACs）会对各种止血检测产生不良干扰，包括狼疮抗凝物（LA）检测，可能出现假阳性和假阴性结果。DOAC Stop（DS）是一种活性炭（AC）产品，用于从测试血浆中特异性有效地吸附DOACs。此过程通常需要在测试前对血浆进行处理、离心和血浆分离，但经验不足的操作人员可能会无意中转移残留的AC颗粒，从而可能对凝血检测产生不利影响。
我们假设残留的DS对机械凝血检测可能没有问题。因此，我们使用机械凝血检测系统研究了DS和一种新型DS液体（DS-L）产品对凝血检测的潜在影响。将不同浓度的DS添加到有和没有DOAC存在的正常和异常血浆中。在分析仪中直接进行包括PT、APTT和dRVVT在内的凝血检测，无需对血浆/DS进行离心。
尽管DS浓度高达推荐治疗水平的两倍时，血浆/试剂混合物中的可见度完全被遮挡，但对所有检测结果的影响很小。这证实了使用机械检测系统时可能可以省略离心步骤。
如果DS残留到处理后的血浆中，这不应对机械凝血传感装置上进行的检测造成问题。此外，我们假设DS可以直接用于这些系统，无需离心，从而简化其许多潜在应用。
