PB1116 - Applications of DOAC removal in the Laboratory

Background: Direct oral anticoagulants (DOACs) have taken the coagulation world by storm with their efficiency and reduced need for monitoring. The effect of DOACs on clotting tests dependent on Factors IIa and Xa is a recognized issue and can cause false positive and negative results. DOAC-Stop is a first-generation agent available to remove DOACs for laboratory testing. There are numerous studies published regarding the use of DOAC-Stop in the laboratory. Waikato hospital's initial mission was to validate the product. The second study highlighted the use of DOAC-Stop in dabigatran poisoning. To date, there aren't any publications using DOAC-Stop for the confirmation of dabigatran poisoning.

Aims: The aim of our study was to validate DOAC-Stop at Waikato hospital for lupus and thrombophilia testing. This study was limited to rivaroxaban and dabigatran. A subsequent study followed to determine if DOAC-Stop can be used to confirm dabigatran poisoning in the setting of rebound coagulopathy.

Methods: All samples were venous collected and drawn in 3.2% sodium citrate tubes. Platelet‐poor plasma was prepared by double centrifugation at 4000 rpm for 10 min at room temperature. Ethical approval was not required as residual plasma was used. A total of 51 samples were used in the initial study. The subsequent study used a total of 30 samples. A pre-treated and post-treated sample using DOAC-Stop were run using a STAR Max 2® - Stago. Data was collated and excel was used for statistical analysis.

Results: DOACs were successfully removed from the plasma.*

Conclusion(s): The study indicates that DOAC-Stop can remove the effects of dabigatran and rivaroxaban from plasma to allow testing for Lupus and Thrombophilia. DOAC-Stop has been implemented at Waikato Hospital. The subsequent study illuminated the potential of using DOAC-Stop not just for thrombophilia testing but to help determine the etiology of a coagulopathy when dabigatran is present.