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Algorithm for Rapid Exclusion of Clinically Relevant Plasma Levels of Direct Oral Anticoagulants in Patients Using the DOAC Dipstick: An Expert Consensus Paper.
- Source :
-
Thrombosis and haemostasis [Thromb Haemost] 2024 Aug; Vol. 124 (8), pp. 770-777. Date of Electronic Publication: 2024 Feb 05. - Publication Year :
- 2024
-
Abstract
- 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.<br />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.<br />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.<br />Competing Interests: J.H. is general manager and founder of DOASENSE GmbH, J.D. is CEO of Qualiblood SA. All other authors declare no conflicts of interest.<br /> (Thieme. All rights reserved.)
- Subjects :
- Humans
Administration, Oral
Hemorrhage
Predictive Value of Tests
Drug Monitoring methods
Anticoagulants therapeutic use
Anticoagulants administration & dosage
Anticoagulants adverse effects
Clinical Decision-Making
Antithrombins
Reagent Strips
Tandem Mass Spectrometry
Reproducibility of Results
Factor Xa Inhibitors blood
Factor Xa Inhibitors therapeutic use
Algorithms
Consensus
Subjects
Details
- Language :
- English
- ISSN :
- 2567-689X
- Volume :
- 124
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Thrombosis and haemostasis
- Publication Type :
- Academic Journal
- Accession number :
- 38316416
- Full Text :
- https://doi.org/10.1055/a-2261-1811