The Influence of DOACS and DOAC-REMOVE® on coagulation assays during thrombophilia testing in DOAC-treated patients

Mirjana Kovač; Dušica Basarić; Branko Tomić; Maja Gvozdenov; Dragana Backović; Sanja Lalić Ćosić

doi:10.2298/VSP210217101K

Mirjana Kovač University of Belgrade, Faculty of Medicine, Institute of Molecular Genetics and Genetic Engineering, Belgrade, Serbia
Dušica Basarić University of Belgrade, nstitute of Molecular Genetics and Genetic Engineering, Belgrade, Serbia
Branko Tomić Blood Transfusion Institute of Serbia, Hemostasis Department, Belgrade, Serbia
Maja Gvozdenov Blood Transfusion Institute of Serbia, Hemostasis Department, Belgrade, Serbia
Dragana Backović University of Belgrade, Faculty of Medicine, Faculty of Pharmacy, Belgrade, Serbia
Sanja Lalić Ćosić University of Belgrade, Faculty of Medicine, Faculty of Pharmacy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP210217101K

Keywords: anticoagulants;, blood coagulation tests;, evaluation study;, thrombophilia.

Abstract

Background/Aim. Direct oral anticoagulants (DOACs) administration significantly interferes with coagulation assays. The aim of the study was to evaluate the effect of DOACs and DOAC-Remove^® on coagulation assays during thrombophilia testing. Methods. The study was carried out from January 2019 to the end of June 2020. It included 30 DOAC-treated patients, 14 females and 16 males aged 23 to 63 (median age 47.6 years), tested for thrombophilia due to venous thromboembolism (VTE). Thrombophilia testing was performed using DOAC-Remove^® tablets (activated charcoal). The results before and after DOAC-Remove^® were compared. Results. Positive lupus anticoagulant (LA) results were observed in 20% apixaban, 100% dabigatran, and 70% rivaroxaban-treated patients, while in samples after DOAC-Remove^®, the LA positivity was observed only in one from the apixaban group. Before DOAC-Remove^®, the activated protein C (APC) resistance (APC-R) was measurable in 40% dabigatran and 80% rivaroxaban-treated patients, while, after using DOAC-Remove^®, the APC-R was measurable in all cases. Comparing the results obtained from the samples before and after DOAC-Remove^®, a difference was noted in relation to all dilute Russell’s viper venom time (dRVVT) coagulation tests, except for the dRVVT ratio in the apixaban group. Clot-based methods for detecting the APC resistance were significantly affected by dabigatran and less by rivaroxaban. Conclusion. DOACs were practically inactivated after the addition of the DOAC-Remove^®, which made it possible to perform analyses for the LA and APC-R testing freely and obtain relevant results.

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