PB1125 - Qualitative and quantitative assessment of direct oral Anticoagulants (DOACs) in Routine Clinical Practice

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Marina Marchetti, PhD (she/her/hers)

Hemostasis Lab Director
Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy

Co-Author(s)

Patricia Gomez Rosas, MD

Hematologist
Hospital Pappa Giovanni XXIII
Bergamo, Lombardia, Italy
CA

Chiara Ambaglio

MD
Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy
ES

Eleonora Sanga

Researcher
Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy
LB

Luca Barcella

MD
Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy
FS

Francesca Schieppati

Hematologist
Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy
JH

Job Harenberg

Professor
Ruprecht Karls University of Heidelberg, Heidelberg, Germany
Heidelberg, Baden-Wurttemberg, Germany
Anna Falanga, MD (she/her/hers)

Professor of Hematology
Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy

Background: DOACs display predictable pharmacokinetic and pharmacodynamic profiles, however, in certain circumstances their measurement becomes useful and vital. DOASENSE Dipstick is a qualitative urine test that detects DOACs, discriminating between the direct factor Xa or thrombin inhibitors.

Aims: To evaluate the reliability of detection of DOASENSE Dipstick with the corresponding plasmatic measurement of anti-Xa and anti-IIa in a routine clinical practice scenario.

Methods: Patients treated with DOACs referred to our outpatient department of thrombosis and hemostasis were included. Reasons for prescription and requesting measurement of DOACs were recorded. Urine qualitative (urine DOASENSE Dipstick) and plasma quantitative (Anti-Xa and Anti-IIa by Stago STA-R Max® assay) levels were measured at trough and peak of DOACs assumption.

Results: A total of 57 (44M/13F) patients, with a median age of 67 years (range: 22-92 years) were studied. Thirty-three patients were treated for thromboembolic events (TEV), 16 patients for non-valvular atrial fibrillation (AF), and 4 for cancer-related thrombosis prophylaxis. Prescribed DOACs were rivaroxaban (21%), dabigatran (18%), edoxaban (35%), and apixaban (26%). Reason for measuring DOACS were, overweight (12%), treatment failure (13%, i.e., thrombotic recurrence), bleeding (4%), renal failure (9%), pharmacological interaction (60%). Plasma concentrations at though were 15.5ng/ml (IQR 5.5-33.8), 21ng/ml (IQR 14.5-34.8) and 85 (IQR 60.8-110), for rivaroxaban, edoxaban and apixaban respectively; and 104 ng/ml (IQR 82.5-200) for dabigatran. Likewise, DOACs concentrations at peak were 121ng/ml (IQR 69.5-185) for rivaroxaban, 201mg/ml (IQR 140-319) for edoxaban and 177ng/ml (IQR 103-215) for apixaban, and 155ng/ml (IQR 122-211) for dabigatran. Detection of urine DOACs at though were positive in all but one patient, and all positive at peak.

Conclusion(s): Qualitative analysis of DOACs was 99% in agreement with its corresponding quantitative measurement, in different clinical monitoring scenarios. In addition, its utility at an emergency unit for screening patients with severe bleeding, and/or thrombotic events, or before urgent major surgical interventions.