AUTHOR=Malik Noor-E.-Huddah , Ward Andrew , Erskine Beth 

TITLE=Comparing the Effect of DOAC-Stop® and DOAC-Remove® on Apixaban, Rivaroxaban and Dabigatran Prior to Thrombophilia and Lupus Testing

JOURNAL=British Journal of Biomedical Science

VOLUME=Volume 81 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/british-journal-of-biomedical-science/articles/10.3389/bjbs.2024.13359

DOI=10.3389/bjbs.2024.13359

ISSN=2474-0896

ABSTRACT=Background: Direct oral anticoagulants (DOACs) interfere with coagulation assays potentially leading to inaccurate results. This study determined the effectiveness of DOAC-stop® and DOAC-remove® in overcoming DOAC-interference and aimed to investigate the extent to which apixaban, rivaroxaban and dabigatran affect thrombophilia and lupus tests by using normal plasma and whether DOACs interfered with true-positive results by testing abnormal controls.Methods: Apixaban (0.03 mg/ml), rivaroxaban (0.01 mg/ml) and dabigatran (0.019 mg/ml) stock solutions were made and added to the normal pool at three varying concentrations (200, 400      and 600 ng/ml) and abnormal controls at a single concentration. These samples and DOAC untreated controls were tested before and after adding either DOAC-stop® or DOAC-remove®. The measured parameters include protein C, protein S, antithrombin III (ATIII), DRVVS, DRVVC, PTTLA and DOAC concentration. The normal pool spiked with DOAC was repeated seven times for each DOAC at each concentration level and the abnormal controls spiked with DOAC were repeated four times at a single concentration level for each DOAC. Results: For the normal pool, dabigatran and rivaroxaban affected all lupus anticoagulant tests, whilst apixaban only affected DRVVS and DRVVC. Whilst dabigatran led to false-positive protein S deficiency and falsely elevated ATIII. Both DOAC-stop® and DOAC-remove® brought the thrombophilia results and all falsely elevated lupus anticoagulant results for apixaban and rivaroxaban back into range. For dabigatran all the affected lupus anticoagulant tests remained abnormal following DOAC-remove®, unlike DOAC-stop® treatment, where only DRVVS and DRVVC at 600 ng/ml remained abnormal. For abnormal controls, all DOACs falsely elevated the lupus anticoagulant tests whilst dabigatran caused false-negative ATIII results which corrected (remained abnormal) with DOAC-stop® and DOAC-remove®. DOAC-stop® showed more reduction of lupus anticoagulant results than DOAC-remove®, causing a false-negative DRVVT ratio for rivaroxaban. Conclusion: DOAC-stop® is more effective than DOAC-remove® since it removed all DOACs below the reference range, whilst DOAC-remove® failed to remove dabigatran.