Presentation Details
| Effect of DOAC Stop on Coagulation Factor Activity Levels Dan A Stephens1, Ronda A Crist1, Karen A Moser1, Allison Carey1, 2, Abdulrahman Saadalla1, 2, Kristi J Smock1, 2. 1ARUP Laboratories Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA.2University of Utah Department of Pathology, Salt Lake City, UT |
Abstract
Introduction Direct oral anticoagulants (DOACs) have variable effects on common clot-based coagulation assays, including spuriously prolonging clotting times, false positive or false negative results in lupus anticoagulant (LA) testing, and falsely decreased one-stage clot-based factor activities. DOAC Stop (DS; Haematex) is an activated charcoal product designed to adsorb DOACs from plasma, reducing or eliminating the potential interference in basic clotting times and LA testing. We aimed to study the effects of DS on coagulation factor activities to determine whether treatment of plasma specimens with DS might impact factor activity levels. Significant off-target removal of coagulation factors would limit the utility of DS in the clinical laboratory. Methods Pooled normal plasma (Precision Biologic) was separated into 2 aliquots. One aliquot was treated with DS following manufacturer’s instructions. Both aliquots were then assayed on a STA-R Evolution analyzer (Diagnostica Stago) for the following: Factors II, V, VII, VIII, IX, X, XI, XII, prekallikrein, fibrinogen (Clauss method), and von Willebrand factor (VWF:RCo) activities; von Willebrand factor antigen (VWF:Ag). The pre-treatment and post-treatment results were compared. Results Pre- and post- treatment factor activities did not demonstrate clinically significant differences. The small differences observed were not biased in one direction and were within the typical coefficients of variation of the assays for repeated testing. Conclusions Other studies have shown that DS can effectively neutralize DOAC effect in certain types of coagulation testing. We have further demonstrated that factor activities are largely unaffected by the treatment of plasma with DS, suggesting that DS could be used prior to performing factor assays and that DS does not show significant adsorption of coagulation factors. Future studies to further understand DS performance could include larger sample numbers and normal and abnormal patient specimens. Evaluation of DS on other von Willebrand factor activity assays may also be useful.
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