Inherited Thrombophilia in the Era of Direct Oral Anticoagulants
Severe inherited thrombophilia includes rare deficiencies of natural anticoagulants (antithrombin and proteins C and S) and homozygous or combined factor V Leiden and FII G20210A variants. They are associated with a high thrombosis risk and can impact the duration of anticoagulation therapy for pati...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-02-01
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| Series: | International Journal of Molecular Sciences |
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| Online Access: | https://www.mdpi.com/1422-0067/23/3/1821 |
| _version_ | 1797487164516204544 |
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| author | Lina Khider Nicolas Gendron Laetitia Mauge |
| author_facet | Lina Khider Nicolas Gendron Laetitia Mauge |
| author_sort | Lina Khider |
| collection | DOAJ |
| description | Severe inherited thrombophilia includes rare deficiencies of natural anticoagulants (antithrombin and proteins C and S) and homozygous or combined factor V Leiden and FII G20210A variants. They are associated with a high thrombosis risk and can impact the duration of anticoagulation therapy for patients with a venous thromboembolism (VTE) event. Therefore, it is important to diagnose thrombophilia and to use adapted anticoagulant therapy. The widespread use of direct anticoagulants (DOACs) for VTE has raised new issues concerning inherited thrombophilia. Concerning inherited thrombophilia diagnosis, DOACs are directed toward either FIIa or FXa and can therefore interfere with coagulation assays. This paper reports DOAC interference in several thrombophilia tests, including the assessment of antithrombin, protein S, and protein C activities. Antithrombin activity and clot-based assays used for proteins C and S can be overestimated, with a risk of missing a deficiency. The use of a device to remove DOACs should be considered to minimize the risk of false-negative results. The place of DOACs in the treatment of VTE in thrombophilia patients is also discussed. Available data are encouraging, but given the variability in thrombosis risk within natural anticoagulant deficiencies, evidence in patients with well-characterized thrombophilia would be useful. |
| first_indexed | 2024-03-09T23:43:41Z |
| format | Article |
| id | doaj.art-485f602b248e468ea7f11199e4f897d3 |
| institution | Directory Open Access Journal |
| issn | 1661-6596 1422-0067 |
| language | English |
| last_indexed | 2024-03-09T23:43:41Z |
| publishDate | 2022-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | International Journal of Molecular Sciences |
| spelling | doaj.art-485f602b248e468ea7f11199e4f897d32023-11-23T16:47:08ZengMDPI AGInternational Journal of Molecular Sciences1661-65961422-00672022-02-01233182110.3390/ijms23031821Inherited Thrombophilia in the Era of Direct Oral AnticoagulantsLina Khider0Nicolas Gendron1Laetitia Mauge2Service de Médecine Vasculaire, Assistance Publique Hôpitaux de Paris-Centre (AP-HP.CUP), F-75015 Paris, FranceInnovative Therapies in Haemostasis, Université de Paris, INSERM, F-75006 Paris, FranceService d’Hématologie Biologique, Assistance Publique Hôpitaux de Paris-Centre (AP-HP.CUP), F-75015 Paris, FranceSevere inherited thrombophilia includes rare deficiencies of natural anticoagulants (antithrombin and proteins C and S) and homozygous or combined factor V Leiden and FII G20210A variants. They are associated with a high thrombosis risk and can impact the duration of anticoagulation therapy for patients with a venous thromboembolism (VTE) event. Therefore, it is important to diagnose thrombophilia and to use adapted anticoagulant therapy. The widespread use of direct anticoagulants (DOACs) for VTE has raised new issues concerning inherited thrombophilia. Concerning inherited thrombophilia diagnosis, DOACs are directed toward either FIIa or FXa and can therefore interfere with coagulation assays. This paper reports DOAC interference in several thrombophilia tests, including the assessment of antithrombin, protein S, and protein C activities. Antithrombin activity and clot-based assays used for proteins C and S can be overestimated, with a risk of missing a deficiency. The use of a device to remove DOACs should be considered to minimize the risk of false-negative results. The place of DOACs in the treatment of VTE in thrombophilia patients is also discussed. Available data are encouraging, but given the variability in thrombosis risk within natural anticoagulant deficiencies, evidence in patients with well-characterized thrombophilia would be useful.https://www.mdpi.com/1422-0067/23/3/1821inherited thrombophiliadirect oral anticoagulantantithrombinprotein Cprotein SDOAC neutralization |
| spellingShingle | Lina Khider Nicolas Gendron Laetitia Mauge Inherited Thrombophilia in the Era of Direct Oral Anticoagulants International Journal of Molecular Sciences inherited thrombophilia direct oral anticoagulant antithrombin protein C protein S DOAC neutralization |
| title | Inherited Thrombophilia in the Era of Direct Oral Anticoagulants |
| title_full | Inherited Thrombophilia in the Era of Direct Oral Anticoagulants |
| title_fullStr | Inherited Thrombophilia in the Era of Direct Oral Anticoagulants |
| title_full_unstemmed | Inherited Thrombophilia in the Era of Direct Oral Anticoagulants |
| title_short | Inherited Thrombophilia in the Era of Direct Oral Anticoagulants |
| title_sort | inherited thrombophilia in the era of direct oral anticoagulants |
| topic | inherited thrombophilia direct oral anticoagulant antithrombin protein C protein S DOAC neutralization |
| url | https://www.mdpi.com/1422-0067/23/3/1821 |
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