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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

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 DO...

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Main Authors: Harenberg, Job (Author) , Gosselin, Robert C. (Author) , Cuker, Adam (Author) , Becattini, Cecilia (Author) , Pabinger, Ingrid (Author) , Poli, Sven (Author) , Weitz, Jeffrey (Author) , Ageno, Walter (Author) , Bauersachs, Rupert (Author) , Celap, Ivana (Author) , Choi, Philip (Author) , Douketis, James (Author) , Douxfils, Jonathan (Author) , Elalamy, Ismail (Author) , Falanga, Anna (Author) , Fareed, Jawed (Author) , Favaloro, Emmanuel J. (Author) , Gerotziafas, Grigorios (Author) , Herkner, Harald (Author) , Hetjens, Svetlana (Author) , Heubner, Lars (Author) , Klamroth, Robert (Author) , Langer, Forian (Author) , Lip, Gregory Y. H. (Author) , Grory, Brian Mac (Author) , Margetić, Sandra (Author) , Merrelaar, Anne (Author) , Pikta, Marika (Author) , Renné, Thomas (Author) , Schulman, Sam (Author) , Schwameis, Michael (Author) , Strbian, Daniel (Author) , Tafur, Alfonso (Author) , Vassart, Julie (Author) , Violi, Francesco (Author) , Walenga, Jeanine (Author) , Weiß, Christel (Author)
Format: Article (Journal)
Language:English
Published: 08. März 2024
In: Thrombosis and haemostasis
Year: 2024, Volume: 124, Issue: 8, Pages: 770-777
ISSN:2567-689X
DOI:10.1055/a-2261-1811
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1055/a-2261-1811
Verlag, lizenzpflichtig, Volltext: http://www.thieme-connect.de/DOI/DOI?10.1055/a-2261-1811
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Author Notes:Job Harenberg, Robert C. Gosselin, Adam Cuker, Cecilia Becattini, Ingrid Pabinger, Sven Poli, Jeffrey Weitz, Walter Ageno, Rupert Bauersachs, Ivana Celap, Philip Choi, James Douketis, Jonathan Douxfils, Ismail Elalamy, Anna Falanga, Jawed Fareed, Emmanuel J. Favaloro, Grigorios Gerotziafas, Harald Herkner, Svetlana Hetjens, Lars Heubner, Robert Klamroth, Forian Langer, Gregory Y.H. Lip, Brian Mac Grory, Sandra Margetić, Anne Merrelaar, Marika Pikta, Thomas Renne, Sam Schulman, Michael Schwameis, Daniel Strbian, Alfonso Tafur, Julie Vassart, Francesco Violi, Jeanine Walenga, Christel Weiss
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Summary: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.
Item Description:Gesehen am 16.09.2024
Physical Description:Online Resource
ISSN:2567-689X
DOI:10.1055/a-2261-1811

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