Title:Application of DOAC-stop in a diagnostic laboratory

Author:Sunny Jamati

Abstract:Objectives: A study was set-up to validate DOAC-Stop at Waikato Hospital laboratory for lupus and thrombophilia testing at the request of a clinician. The study was limited to the DOACs, rivaroxaban and dabigatran.
Methods: Samples had coagulation tests pre- and post-treatment. Tests included: INR, APTT, fibrinogen, TCT, dabigatran assay, rivaroxaban assay, non-sensitive APTT, antithrombin III assay, dRVVC, and dRVVT.
Results: DOAC-Stop significantly removed dabigatran and rivaroxaban from the residual plasma. It had little effect on non-DOAC plasma.
Conclusions: This study indicated that DOAC-Stop can remove the effects of dabigatran and rivaroxaban from plasma to allow the testing for Lupus and Thrombophilia. DOAC-Stop has been implemented at Waikato Hospital and is used routinely, with the provision that either a TCT for dabigatran or rivaroxaban assay for rivaroxaban is added post-treatment to prove a successful reversal. Regardless, it is important to interpret treated plasma with caution as DOAC-Stop has demonstrated some variability in the coagulation cascade.
Key words: Direct oral anticoagulants; rapid reversal; dabigatran; rivaroxaban; activated charcoal; DOAC-Stop.
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