DOAC Dipstick Testing Can Reliably Exclude the Presence of Clinically Relevant DOAC Concentrations in Circulation

Scientific paper - Original scientific paper

• Author: Sandra Margetić
• Author: Ivana Ćelap
• Author: Arijana Lovrenčić Huzjan
• Author: Marijana Bosnar Puretić
• Author: Sandra Šupraha Goreta
• Author: Anesa Čajević Glojnarić
• Author: Diana Delić Brkljačić
• Author: Pavao Mioč
• Author: Job Harenberg
• Author: Svetlana Hetjens
• Author: Christel Weiss
• Author's institution: University of Zagreb; School of Medicine; (Department of Internal Medicine)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract (english)

In certain clinical situations, it is necessary to determine whether clinically relevant plasma levels of direct oral anticoagulants (DOACs) are present. We examined whether qualitative testing of DOACs in urine samples can exclude DOAC plasma concentrations of ≥30 ng/mL. This prospective single-center cohort study included consecutive patients treated with an oral direct factor Xa inhibitor (DXI) (apixaban, n = 31, rivaroxaban, n = 53) and direct thrombin inhibitor (DTI) (dabigatran, n = 44). We aimed to define the negative predictive value (NPV) and other statistical parameters of detecting DXIs and DTIs by DOAC Dipstick at plasma concentrations of ≥30 ng/mL. We also determined the best-fit threshold plasma levels using chromogenic substrate assays by logistic regression analysis. Between July 2020 and July 2021, 128 eligible patients (mean age 66 years, 55 females) were included into the study. The NPVs and sensitivities for DXI and DTI of DOAC Dipstick were 100% at ≥30 ng/mL plasma, for specificities 6 and 21% and for positive predictive values 62 and 72%, respectively. All diagnostic statistical tests improved to values between 86 and 100% at best-fitting plasma thresholds of ≥14 ng/mL for DXI and ≥19 ng/mL for DTI. Visual analysis using the DOAC Dipstick was 100% in agreement with that of the optoelectronic DOASENSE Reader for all the three DOACs. DOAC Dipstick testing can reliably exclude the presence of DOACs in urine samples at best-fitting thresholds of >14 and >19 ng/mL in plasma. The performance of the DOAC Dipstick at detecting lower DOAC concentrations in plasma requires confirmation.

• Keywords (english): Administration, Oral; Aged; Anticoagulants; Antithrombins; Cohort Studies; Dabigatran; Factor Xa Inhibitors; Female; Humans; Prospective Studies; Pyridones; Rivaroxaban
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Thrombosis and Haemostasis
• Numbering: vol. 122, no. 9, pp. 1542-1548
• p-ISSN: 0340-6245
• e-ISSN: 2567-689X
• DOI: https://doi.org/10.1055/a-1753-2748
• URN:NBN: urn:nbn:hr:105:863334
• Publication: 2022-09
• Project: Number: IP-2016-06-8208; Title (croatian): Novi oralni antikoagulansi: povezanost koncentracije lijeka i antikoagulantnog učinka; Acronym: LAB-NOAC; Leader: Sandra Margetić; Jurisdiction: Croatia; Funding stream: IP
• Document URL: http://www.thieme-connect.de/DOI/DOI?10.1055/a-1753-2748
• Type of resource: Text
• Access conditions: Open access
• Created on: 2022-11-14 12:21:48