Background: Direct (anti-IIa and anti-Xa) oral anticoagulants (DOACs) are known to induce changes in various coagulation parameters. Different devices able to neutralize or abolish their effect in vitro enable their reliable measurement.
Aims: To evaluate the performance of the activated charcoal DOAC-Remove (5-Diagnostic, Basel, Switzerland) in extracting DOACs from plasma samples.
Methods: We evaluated left-over plasmas from untreated patients and patients treated with dabigatran rivaroxaban, or apixaban obtained in the laboratory workload. Tests were performed before and after a x min-incubation of 0.8 mL plasma sample with 1 tablet of the charcoal. This included DOAC were measured using a specific direct thrombin inhibitor or an anti-Xa assay, routine coagulation testes (PT, aPTT, and fibrinogen), and thrombophilia panel including antithrombin, protein C (PC, chromogenic and clotting assays), and PS (free PS antigen and clotting assays). All assays were performed using reagents from Werfen on the ACL TOP 700 analyzer.
Results: In untreated patients, the DOAC-Remove had no significant effect on the test results (n>30 for each parameter). In treated patients, the DOAC-Remove completely eliminated any of the three DOACs, with levels below the detection limit of the techniques (n>30 for each DOAC), with a dramatic correction of the DOAC-induced prolongations of PT and APTT. The same applied to elevated PC and PS anticoagulant activities (clotting assays) found in plasmas from patients treated with any of the three DOACs, and for antithrombin activity in the plasma from patients on rivaroxaban and apixaban. The DOAC-Remove had no impact on PC activity evaluated using a chromogenic assay, and on free PS antigen concentration, which were not affected with any of the 3 DOACs.
Conclusions: The DOAC-Remove effectively removed all 3 tested DOACs from the plasma of treated patients. Accordingly, routine coagulation and thrombophilia assays can validly be performed in treated patients without withholding the treatment..
To cite this abstract in AMA style:Vannini M, Dahmani B, Appert-Flory A, Fischer F, Jambou D, Toulon P. Activated Charcoal to Remove DOAC from Patients’ Plasma. Potential Usefulness for Routine Coagulation and Thrombophilia Testing in DOAC Treated Patients [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/activated-charcoal-to-remove-doac-from-patients-plasma-potential-usefulness-for-routine-coagulation-and-thrombophilia-testing-in-doac-treated-patients/. Accessed November 30, 2023.
« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/activated-charcoal-to-remove-doac-from-patients-plasma-potential-usefulness-for-routine-coagulation-and-thrombophilia-testing-in-doac-treated-patients/