DOAC‐Stop in lupus anticoagulant testing: Direct oral anticoagulant interference removed in most samples
Abstract Background The use of direct oral anticoagulants (DOACs) is a convenient therapeutic option for patients at risk of thrombosis. DOACs interfere with clot‐based testing for the identification of lupus anticoagulant antibodies (LACs) in patients with antiphospholipid syndrome (APS), a common...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-02-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rth2.12472 |
| _version_ | 1797705656011063296 |
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| author | Steven Andrew Baker Jing Jin Christopher Pfaffroth Trang Vu James L. Zehnder |
| author_facet | Steven Andrew Baker Jing Jin Christopher Pfaffroth Trang Vu James L. Zehnder |
| author_sort | Steven Andrew Baker |
| collection | DOAJ |
| description | Abstract Background The use of direct oral anticoagulants (DOACs) is a convenient therapeutic option for patients at risk of thrombosis. DOACs interfere with clot‐based testing for the identification of lupus anticoagulant antibodies (LACs) in patients with antiphospholipid syndrome (APS), a common cause of acquired thrombotic disease. Objectives To evaluate a commercially available reagent DOAC‐Stop for the removal of DOAC interference encountered in LAC testing. Patients/Methods We collected a cohort of 73 test samples from patients on DOAC therapy identified at a large institutional coagulation laboratory from March to December 2019, along with samples from 40 LAC positive and negative control patients not on therapy. Samples were treated with DOAC‐Stop and tested for anti‐Xa activity and thrombin time for the removal of apixaban, rivaroxaban, argatroban, and dabigatran activity from patient samples. Treated and untreated samples were tested using the activated partial thromboplastin time, silica clotting time, and dilute Russell’s viper venom time to evaluate the reliability and utility of DOAC‐Stop. Results DOAC‐Stop markedly reduced DOAC interference from test samples (P < .05). DOAC‐Stop had no effect on LAC testing in the absence of DOAC therapy, permitting the identification of all LAC positive and negative controls. DOAC‐Stop removed false positives and false negatives resulting from DOAC interference and allows the identification of patients meeting criteria for the diagnosis of APS by LAC testing, as well as the detection of patients on rivaroxaban who are triple positive for APS. Conclusions DOAC‐Stop is an effective adjunct for the clinical laboratory faced with DOAC interference in LAC testing. |
| first_indexed | 2024-03-12T05:40:33Z |
| format | Article |
| id | doaj.art-74b6cb60d8ae46d0af41cadec962aeb4 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T05:40:33Z |
| publishDate | 2021-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-74b6cb60d8ae46d0af41cadec962aeb42023-09-03T06:08:17ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792021-02-015231432510.1002/rth2.12472DOAC‐Stop in lupus anticoagulant testing: Direct oral anticoagulant interference removed in most samplesSteven Andrew Baker0Jing Jin1Christopher Pfaffroth2Trang Vu3James L. Zehnder4Department of Pathology Stanford University School of Medicine Stanford CA USADepartment of Special Coagulation Clinical Laboratory Stanford Health Care Palo Alto CA USADepartment of Special Coagulation Clinical Laboratory Stanford Health Care Palo Alto CA USADepartment of Special Coagulation Clinical Laboratory Stanford Health Care Palo Alto CA USADepartment of Pathology Stanford University School of Medicine Stanford CA USAAbstract Background The use of direct oral anticoagulants (DOACs) is a convenient therapeutic option for patients at risk of thrombosis. DOACs interfere with clot‐based testing for the identification of lupus anticoagulant antibodies (LACs) in patients with antiphospholipid syndrome (APS), a common cause of acquired thrombotic disease. Objectives To evaluate a commercially available reagent DOAC‐Stop for the removal of DOAC interference encountered in LAC testing. Patients/Methods We collected a cohort of 73 test samples from patients on DOAC therapy identified at a large institutional coagulation laboratory from March to December 2019, along with samples from 40 LAC positive and negative control patients not on therapy. Samples were treated with DOAC‐Stop and tested for anti‐Xa activity and thrombin time for the removal of apixaban, rivaroxaban, argatroban, and dabigatran activity from patient samples. Treated and untreated samples were tested using the activated partial thromboplastin time, silica clotting time, and dilute Russell’s viper venom time to evaluate the reliability and utility of DOAC‐Stop. Results DOAC‐Stop markedly reduced DOAC interference from test samples (P < .05). DOAC‐Stop had no effect on LAC testing in the absence of DOAC therapy, permitting the identification of all LAC positive and negative controls. DOAC‐Stop removed false positives and false negatives resulting from DOAC interference and allows the identification of patients meeting criteria for the diagnosis of APS by LAC testing, as well as the detection of patients on rivaroxaban who are triple positive for APS. Conclusions DOAC‐Stop is an effective adjunct for the clinical laboratory faced with DOAC interference in LAC testing.https://doi.org/10.1002/rth2.12472antibodiesantiphospholipidantiphospholipid syndromeapixabanlupus coagulation inhibitorpartial thromboplastin time |
| spellingShingle | Steven Andrew Baker Jing Jin Christopher Pfaffroth Trang Vu James L. Zehnder DOAC‐Stop in lupus anticoagulant testing: Direct oral anticoagulant interference removed in most samples Research and Practice in Thrombosis and Haemostasis antibodies antiphospholipid antiphospholipid syndrome apixaban lupus coagulation inhibitor partial thromboplastin time |
| title | DOAC‐Stop in lupus anticoagulant testing: Direct oral anticoagulant interference removed in most samples |
| title_full | DOAC‐Stop in lupus anticoagulant testing: Direct oral anticoagulant interference removed in most samples |
| title_fullStr | DOAC‐Stop in lupus anticoagulant testing: Direct oral anticoagulant interference removed in most samples |
| title_full_unstemmed | DOAC‐Stop in lupus anticoagulant testing: Direct oral anticoagulant interference removed in most samples |
| title_short | DOAC‐Stop in lupus anticoagulant testing: Direct oral anticoagulant interference removed in most samples |
| title_sort | doac stop in lupus anticoagulant testing direct oral anticoagulant interference removed in most samples |
| topic | antibodies antiphospholipid antiphospholipid syndrome apixaban lupus coagulation inhibitor partial thromboplastin time |
| url | https://doi.org/10.1002/rth2.12472 |
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