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The effect of DOACs on laboratory tests and their removal by activated carbon to limit interference in functional assays.
Int J Lab Hematol. 2020 Jun; 42 Suppl 1:41-48.IJ

Abstract

We aimed to review the interfering effect of DOACs on tests for haemostatic function and then to discuss overcoming these with activated carbon (AC) products, thereby eliminating DOAC issues from test plasmas. Recent relevant articles were reviewed and are discussed. Laboratory tests for DOACs, lupus anticoagulant, factor assays and APC Resistance were carried out in such publications with and without an AC product on various instruments using reagents approved for diagnostic use in well-regulated clinical laboratories. All reports on this plasma pre-treatment by AC products agree that they extract DOACs from plasma samples with minimal effect on underlying clotting tests. The specific extraction of DOACs significantly reduced false positive lupus anticoagulant detection and provided more reliable results in clotting factor assays, APC resistance and other thrombophilia tests. Dabigatran and edoxaban seem to be adsorbed more thoroughly by AC from plasmas than rivaroxaban and apixaban. In summary, most of the AC products reviewed here appear to remove DOACs from test plasmas without significantly affecting underlying clotting tests and permit correct diagnosis of various haemostatic conditions despite the initial presence of DOACs. The application of such agents as a sample pre-treatment to overcome the effects of DOACs for routine coagulation testing is supported by the emerging literature.

Authors+Show Affiliations

Haematex Research Lab, Sydney, NSW, Australia.Haematology Department, Alfred Hospital, Melbourne, Vic., Australia.Laboratory Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Sydney, NSW, Australia. Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Sydney, NSW, Australia.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32543072

Citation

Exner, Thomas, et al. "The Effect of DOACs On Laboratory Tests and Their Removal By Activated Carbon to Limit Interference in Functional Assays." International Journal of Laboratory Hematology, vol. 42 Suppl 1, 2020, pp. 41-48.
Exner T, Rigano J, Favaloro EJ. The effect of DOACs on laboratory tests and their removal by activated carbon to limit interference in functional assays. Int J Lab Hematol. 2020;42 Suppl 1:41-48.
Exner, T., Rigano, J., & Favaloro, E. J. (2020). The effect of DOACs on laboratory tests and their removal by activated carbon to limit interference in functional assays. International Journal of Laboratory Hematology, 42 Suppl 1, 41-48. https://doi.org/10.1111/ijlh.13196
Exner T, Rigano J, Favaloro EJ. The Effect of DOACs On Laboratory Tests and Their Removal By Activated Carbon to Limit Interference in Functional Assays. Int J Lab Hematol. 2020;42 Suppl 1:41-48. PubMed PMID: 32543072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of DOACs on laboratory tests and their removal by activated carbon to limit interference in functional assays. AU - Exner,Thomas, AU - Rigano,Joseph, AU - Favaloro,Emmanuel J, PY - 2020/6/17/entrez KW - DOAC KW - DOAC Remove KW - DOAC Stop™ KW - aPTT KW - activated carbon KW - apixaban KW - dRVVT KW - dabigatran KW - edoxaban KW - lupus anticoagulant KW - rivaroxaban KW - thrombophilia SP - 41 EP - 48 JF - International journal of laboratory hematology JO - Int J Lab Hematol VL - 42 Suppl 1 N2 - We aimed to review the interfering effect of DOACs on tests for haemostatic function and then to discuss overcoming these with activated carbon (AC) products, thereby eliminating DOAC issues from test plasmas. Recent relevant articles were reviewed and are discussed. Laboratory tests for DOACs, lupus anticoagulant, factor assays and APC Resistance were carried out in such publications with and without an AC product on various instruments using reagents approved for diagnostic use in well-regulated clinical laboratories. All reports on this plasma pre-treatment by AC products agree that they extract DOACs from plasma samples with minimal effect on underlying clotting tests. The specific extraction of DOACs significantly reduced false positive lupus anticoagulant detection and provided more reliable results in clotting factor assays, APC resistance and other thrombophilia tests. Dabigatran and edoxaban seem to be adsorbed more thoroughly by AC from plasmas than rivaroxaban and apixaban. In summary, most of the AC products reviewed here appear to remove DOACs from test plasmas without significantly affecting underlying clotting tests and permit correct diagnosis of various haemostatic conditions despite the initial presence of DOACs. The application of such agents as a sample pre-treatment to overcome the effects of DOACs for routine coagulation testing is supported by the emerging literature. SN - 1751-553X UR - https://www.unboundmedicine.com/medline/citation/32543072/The_effect_of_DOACs_on_laboratory_tests_and_their_removal_by_activated_carbon_to_limit_interference_in_functional_assays L2 - https://doi.org/10.1111/ijlh.13196 DB - PRIME DP - Unbound Medicine ER -
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