DOAC-Remove abolishes the effect of direct oral anticoagulants on activated protein C resistance testing in real-life venous thromboembolism patients

被引:13
作者
Kopytek, Magdalena [1 ,3 ]
Zabczyk, Michal [1 ,3 ]
Malinowski, Krzysztof P. [4 ]
Undas, Anetta [1 ,3 ]
Natorska, Joanna [1 ,2 ]
机构
[1] John Paul 2 Hosp, Krakow, Poland
[2] Jagiellonian Univ, Sch Med, 80 Pradnicka St, PL-31202 Krakow, Poland
[3] Jagiellonian Univ, Inst Cardiol, Med Coll, Krakow, Poland
[4] Jagiellonian Univ, Med Coll, Fac Hlth Sci, Krakow, Poland
关键词
activated protein C resistance (APC-R); direct oral anticoagulants (DOACs); DOAC-Remove; factor V Leiden mutation (FVL); venous thromboembolism (VTE); PROTHROMBINASE-BASED ASSAY; FACTOR-V-LEIDEN; RIVAROXABAN; THROMBOPHILIA; PREVENTION; DABIGATRAN; THROMBOSIS; MUTATION;
D O I
10.1515/cclm-2019-0650
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
Background: Direct oral anticoagulants (DOACs) may cause false results of activated protein C resistance (APC-R) ratio. DOAC-Remove, a new reagent based on activated carbon, has been designed to eliminate the interference of DOACs on coagulation assays. The aim of the study was to investigate whether the use of DOAC-Remove enables to determine APC-R in patients treated with DOACs. Methods: We assessed 74 venous thromboembolism (VTE) patients, including 25 on rivaroxaban, 25 on apixaban and 24 taking dabigatran. APC-R was determined using the Russell Viper Venom Time (RVVT)-based clotting test. APC-R and DOAC concentrations were tested at baseline and following DOAC-Remove. Thrombophilia, including factor V Leiden (FVL) mutation was tested. Results: FVI, mutation was found in 20 (27%) patients. The APC-R ratio at baseline was measurable in 43 patients (58.1%), including 20 (80%) on rivaroxaban, 19 (76%) on apixaban and four (16.7%) on dabigatran. In patients with measurable APC-R at baseline, the ratio >2.9 was found in 23 patients (53.5%). In 16 (37.2%) subjects APC-R ratio <1.8 suggested FVL mutation which was genetically confirmed. Four (93%) FVL carriers on dabigatran showed negative/equivocal APC-R results. In 11 (14.9%) patients taking rivaroxaban or apixaban, in whom blood was collected 2-5 h since the last dose, we observed unmeasurable APC-R. DOAC-Remove almost completely eliminated all plasma DOACs. After addition of DOAC-Remove all APC-R ratios were measurable. In four FVL carriers on dabigatran with false negative APC-R, DOAC-Remove resulted in APC-R ratios <1.8. Conclusions: DOAC-Remove effectively reduces DOACs Concentration in plasma, which enables FVL testing using APC-R.
引用
收藏
页码:430 / 437
页数:8
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