The effect of DOAC-Stop on lupus anticoagulant testing in plasma samples of venous thromboembolism patients receiving direct oral anticoagulants

• Published in: Clinical chemistry and laboratory medicine Vol. 57; no. 9; pp. 1374 - 1381
• Main Authors: Ząbczyk, Michał, Kopytek, Magdalena, Natorska, Joanna, Undas, Anetta
• Format: Journal Article
• Language: English
• Published: Germany De Gruyter 01.09.2019; Walter De Gruyter & Company
• Subjects: Administration, Oral; Adult; Anticoagulants; Anticoagulants - pharmacology; Antiphospholipid syndrome; Antiphospholipid Syndrome - diagnosis; antiphospholipid syndrome testing; Autoimmune diseases; Blood Coagulation - drug effects; Blood Coagulation Tests - methods; Clotting; Dabigatran - pharmacology; direct oral anticoagulants (DOAC); DOAC-Stop; Factor Xa Inhibitors - chemistry; Factor Xa Inhibitors - metabolism; Factor Xa Inhibitors - pharmacology; False Positive Reactions; Female; Humans; Lupus; lupus anticoagulant; Lupus Coagulation Inhibitor - analysis; Lupus Coagulation Inhibitor - blood; Lupus Coagulation Inhibitor - drug effects; Male; Middle Aged; Partial Thromboplastin Time; Plasma - metabolism; Prothrombin Time; Pyrazoles; Pyridones; Rivaroxaban - pharmacology; Screening; Systemic lupus erythematosus; Test procedures; Thromboembolism; Thromboplastin; Venom; Venous Thromboembolism - drug therapy; Venous Thromboembolism - metabolism; antiphospholipid syndrome testing; direct oral anticoagulants (DOAC); lupus anticoagulant; DOAC-Stop
• ISSN: 1434-6621; 1437-4331; 1437-4331
• DOI: 10.1515/cclm-2018-1197

Background Direct oral anticoagulants (DOACs) cause false positive lupus anticoagulant (LA) results. We assessed the impact of DOAC-Stop, reversing in vitro effects of DOACs, on LA testing in anticoagulated patients. Methods We assessed 75 venous thromboembolism patients aged 44.5±14.6 years. Blood samples were collected 2-28 h since intake of DOACs, including 50 patients on rivaroxaban, 20 on dabigatran and five on apixaban. LA testing was performed at baseline and after DOAC-Stop treatment. Positive LA was defined as the normalized (patient/standard plasma clotting time) LA screening and screening (LA1)/confirmation (LA2) ratios exceeding 1.2. Results LA diluted Russell's viper venom time (dRVVT) normalized screening test revealed abnormal results in 73 (97.3%) and activated partial thromboplastin time (APTT)-LA in 49 (65.3%) patients. In six (8%) patients, antiphospholipid syndrome (APS) was diagnosed. dRVVT LA1/LA2 was abnormal in 35 (50.7%) patients taking DOACs. The APTT ratio was normal in all studied subjects. DOAC-Stop completely removed dabigatran and reduced by 98% rivaroxaban and by 92.3% apixaban concentrations (all p<0.05). After DOAC-Stop screening dRVVT remained prolonged in 34 (49.3%) patients (p<0.001), while dRVVT LA1/LA2 was abnormal in six (8.7%) subjects, with no association with DOAC concentrations at baseline and after DOAC-Stop. The APTT-LA screening test remained prolonged in five (7.2%) patients, while the APTT LA1/LA2 ratio was normal in those subjects. DOAC-Stop did not influence LA testing in APS patients. Conclusions Application of DOAC-Stop effectively reduced plasma DOAC concentrations leading to appropriate dRVVT results in up to 97% of VTE patients.