Why the study?
Regulatory labeling on DOAC influences on diagnostic tests is limited to common assays with no head-to-head comparisons, risking misinterpretation of thrombophilia results.
How do direct oral anticoagulants impact the results of thrombophilia diagnostic tests?
How do direct oral anticoagulants impact the results of thrombophilia diagnostic tests?
DOACs can cause false-positive or false-negative results in clot-based thrombophilia diagnostic tests, necessitating caution in interpretation or the use of DOAC-insensitive assays.
Answers are grounded in this paper and cite their sources.
Clinicians should interpret clot-based thrombophilia tests cautiously during DOAC therapy; leaves open optimal assay selection for accurate diagnosis.
There is a laboratory and clinical need to know the impact of direct oral anticoagulants (DOACs) on diagnostic tests to avoid misinterpretation of results. Although the regulatory labelling documents provide some information about the influences of each DOAC on diagnostic tests, these are usually limited to some of the most common tests and no head to head comparison is available. In this paper, we report the impact of DOACs on several thrombophilia tests, including assessment of antithrombin, protein S and protein C activity assays, detection of activated protein C resistance and assays used for lupus anticoagulant. Results are compared and discussed with data obtained from literature. The final goal of this comprehensive review is to provide practical recommendations for laboratories to avoid misdiagnosis due to oral direct factor Xa (FXa) or IIa (FIIa) inhibitors. Overall, oral direct FXa (apixaban, betrixaban, edoxaban and rivaroxaban) and FIIa (dabigatran) antagonists may affect clot-based thrombophilia diagnostic tests resulting in false-positive or false-negative results. An effect on FIIa-based thrombophilia diagnostic tests is observed with dabigatran but not with anti-FXa DOACs and conversely for FXa-based thrombophilia diagnostic tests. No impact was observed with antigenic/chromogenic methods for the assessment of protein S and C activity. In conclusion, interpretation of thrombophilia diagnostic tests results should be done with caution in patients on DOACs. The use of a device/chemical compound able to remove or antagonize the effect of DOACs or the development of new diagnostic tests insensitive to DOACs should be considered to minimize the risk of false results.
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Siriez et al. (2020) studied this question.
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