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DOI: 10.1055/a-2261-1811
Algorithm for Rapid Exclusion of Clinically Relevant Plasma Levels of Direct Oral Anticoagulants in Patients Using the DOAC Dipstick: An Expert Consensus Paper
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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.
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.
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.
Authors' Contribution
Conception of the work: initially by J.H., S.H., A.M., M.S., C.W. and a DOAC POCT meeting held on the occasion of the XXIII ISTH congress by all authors. Two-thirds of the authors participated in person and one-third virtually and approved the conception. Acquisition of data: I.C., P.C., H.H., S.H., A.M., M.P., M.S., J.V., C.W. Statistical analysis: H.H., S.H., C.W. Laboratory methods: J.D., J.V., I.C., P.C., A.M., M.S., M.P. Drafting: J.H., R.C.G., A.C., C.B., I.P., S.P., J.W. Reviewing: All authors. Agreement and final approval: All authors.
The review process for this paper was fully handled by Christian Weber, Editor in Chief.
Publication History
Received: 07 July 2023
Accepted: 08 December 2023
Accepted Manuscript online:
05 February 2024
Article published online:
08 March 2024
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