Algorithm for Rapid Exclusion of Clinically Relevant Plasma Levels of Direct Oral Anticoagulants in Patients Using the DOAC Dipstick
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Algorithm for Rapid Exclusion of Clinically Relevant Plasma Levels of Direct Oral Anticoagulants in Patients Using the DOAC Dipstick. / Harenberg, Job; Gosselin, Robert Charles; Cuker, Adam; Becattini, Cecilia; Pabinger, Ingrid; Poli, Sven; Weitz, Jeffrey Ian; Ageno, Walter; Bauersachs, Rupert; Ćelap, Ivana; Choi, Philip; Douketis, James; Douxfils, Jonathan; Elalamy, Ismail; Fareed, Jawed; Falanga, Anna; Favalor, Emmanuel; Gerotziafas, Grigoris T; Herkner, Harald; Hetjens, Svetlana; Klamroth, Robert; Heubner, Lars; Langer, Florian; Lip, Gregory Yh; Mac Grory, Brain; Margetić, Sandra; Merrelaar, Anne; Pikta, Marika; Renne', Thomas; Schwameis, Michael; Schulman, Sam; Strbian, Daniel; Tafur, Alfonso; Violi, Francesco; Vassart, Julie; Walenga, Jeanine; Weiss, Christel.
In: THROMB HAEMOSTASIS, Vol. 124, No. 8, 08.2024, p. 770-777.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Algorithm for Rapid Exclusion of Clinically Relevant Plasma Levels of Direct Oral Anticoagulants in Patients Using the DOAC Dipstick
AU - Harenberg, Job
AU - Gosselin, Robert Charles
AU - Cuker, Adam
AU - Becattini, Cecilia
AU - Pabinger, Ingrid
AU - Poli, Sven
AU - Weitz, Jeffrey Ian
AU - Ageno, Walter
AU - Bauersachs, Rupert
AU - Ćelap, Ivana
AU - Choi, Philip
AU - Douketis, James
AU - Douxfils, Jonathan
AU - Elalamy, Ismail
AU - Fareed, Jawed
AU - Falanga, Anna
AU - Favalor, Emmanuel
AU - Gerotziafas, Grigoris T
AU - Herkner, Harald
AU - Hetjens, Svetlana
AU - Klamroth, Robert
AU - Heubner, Lars
AU - Langer, Florian
AU - Lip, Gregory Yh
AU - Mac Grory, Brain
AU - Margetić, Sandra
AU - Merrelaar, Anne
AU - Pikta, Marika
AU - Renne', Thomas
AU - Schwameis, Michael
AU - Schulman, Sam
AU - Strbian, Daniel
AU - Tafur, Alfonso
AU - Violi, Francesco
AU - Vassart, Julie
AU - Walenga, Jeanine
AU - Weiss, Christel
N1 - Thieme. All rights reserved.
PY - 2024/8
Y1 - 2024/8
N2 - BACKGROUND: With the widespread use of direct oral anticoagulants (DOACs), there is an urgent need for a rapid assay to exclude clinically relevant plasma levels. Accurate and rapid determination of DOAC levels would guide medical decision-making to (1) determine the potential contribution of the DOAC to spontaneous or trauma-induced hemorrhage; (2) identify appropriate candidates for reversal, or (3) optimize the timing of urgent surgery or intervention.METHODS AND RESULTS: The DOAC Dipstick test uses a disposable strip to identify factor Xa- or thrombin inhibitors in a urine sample. Based on the results of a systematic literature search followed by an analysis of a simple pooling of five retrieved clinical studies, the test strip has a high sensitivity and an acceptably high negative predictive value when compared with levels measured with liquid chromatography tandem mass spectrometry or calibrated chromogenic assays to reliably exclude plasma DOAC concentrations ≥30 ng/mL.CONCLUSION: Based on these data, a simple algorithm is proposed to enhance medical decision-making in acute care indications useful primarily in hospitals not having readily available quantitative tests and 24/7. This algorithm not only determines DOAC exposure but also differentiates between factor Xa and thrombin inhibitors to better guide clinical management.
AB - BACKGROUND: With the widespread use of direct oral anticoagulants (DOACs), there is an urgent need for a rapid assay to exclude clinically relevant plasma levels. Accurate and rapid determination of DOAC levels would guide medical decision-making to (1) determine the potential contribution of the DOAC to spontaneous or trauma-induced hemorrhage; (2) identify appropriate candidates for reversal, or (3) optimize the timing of urgent surgery or intervention.METHODS AND RESULTS: The DOAC Dipstick test uses a disposable strip to identify factor Xa- or thrombin inhibitors in a urine sample. Based on the results of a systematic literature search followed by an analysis of a simple pooling of five retrieved clinical studies, the test strip has a high sensitivity and an acceptably high negative predictive value when compared with levels measured with liquid chromatography tandem mass spectrometry or calibrated chromogenic assays to reliably exclude plasma DOAC concentrations ≥30 ng/mL.CONCLUSION: Based on these data, a simple algorithm is proposed to enhance medical decision-making in acute care indications useful primarily in hospitals not having readily available quantitative tests and 24/7. This algorithm not only determines DOAC exposure but also differentiates between factor Xa and thrombin inhibitors to better guide clinical management.
U2 - 10.1055/a-2261-1811
DO - 10.1055/a-2261-1811
M3 - SCORING: Journal article
C2 - 38316416
VL - 124
SP - 770
EP - 777
JO - THROMB HAEMOSTASIS
JF - THROMB HAEMOSTASIS
SN - 0340-6245
IS - 8
ER -