Abstract Number: PB0367
Meeting: ISTH 2021 Congress
Background: The DOAC DipstickTM accurately determines the presence or absence of oral direct factor Xa (DXI) or oral direct thrombin inhibitors (DTI) in urine samples from patients treated with these classes of direct oral anticoagulants (DOACs). Several studies have investigated the performance of prototype and commercial dipsticks.
Aims: We aim to compare the performance of prototype and commercial dipsticks in a systematic review and meta-analysis to analyze the robustness and consistency of the data collected in these different studies.
Methods: We systematically searched PubMed (MEDLINE) and the Cochrane Library for relevant articles. Heterogeneity between studies was calculated using the chi-squared heterogeneity test and I² index. A random effects model was used to compare data for prototype and commercial dipsticks.
Results: Four of 1081 publications were considered eligible for inclusion; three reported results on prototype dipsticks (DXI n=658, DTI n=586) and one on commercial dipsticks (DXI n=451, DTI n=429). There were no significant differences in sensitivity and specificity of DXI and DTI detection between prototype and commercial dipsticks. The pooled sensitivity and specificity was 0.968 (95%CI 0.956-0.978, p=0.1290, I² 47.1%) and 0.979 (95%CI 0.968-0.992, p=0.1965, I² 35.9%) respectively for detecting DXIs and 0.993 (95%CI 0.986-0.997, p=0.1870, I² 37.5%) and 0.993 (95%CI 0.986-0.997, p=0.7380, I² 0%) respectively for detecting DTIs. Simulation down to 1% prevalence showed a very high negative predictive value of 0.999, indicating that the dipstick test may remain valid for detecting DOACs in patients’ urine with acute medical conditions, and a still high positive predictive value between 0.238 and 0.590 for type of DOAC probably depending upon population and renal function.
Conclusions: Detection of DXI and DTI in patient urine samples was not significantly different between prototype and commercial DOAC dipsticks. This strengthens the reported results and should increase confidence to use of the DOAC Dipstick in emergency patient care and other medical indications.
To cite this abstract in AMA style:Martini A, Bauersachs R, Beyer Westendorf J, Crowther M, Douxfils J, Elalamy I, Harenberg J, Hetjens S, Weiss C. A Systematic Review and Meta-analysis of Performances of Prototype and Commercial DOAC Dipstick Tests for Detecting Direct Oral Anticoagulants in Patient Urine Samples – Increasing Confidence for Testing in Emergency Care [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/a-systematic-review-and-meta-analysis-of-performances-of-prototype-and-commercial-doac-dipstick-tests-for-detecting-direct-oral-anticoagulants-in-patient-urine-samples-increasing-confidence/. Accessed December 7, 2021.
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