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Thromb Haemost
DOI: 10.1055/a-2695-2674
Review Article

Usefulness and Limits of DOAC Removal Agents Based on Activated Charcoal in Thrombophilia Testing: Literature Review and Expert Proposals

Authors

  • Georges Jourdi 

    1   Service d'Hématologie Biologique, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris Nord (APHP.Nord), Paris, France
    2   Université Paris Cité, INSERM, UMRS-1144, Optimisation Thérapeutique en Neuropharmacologie, Paris, France

  • Claire Flaujac 

    3   Laboratoire de Biologie Médicale (Secteur Hémostase), Centre Hospitalier de Versailles - Hôpital André Mignot, Le Chesnay-Rocquencourt, France

  • Emmanuel De Maistre 

    4   Laboratoire d'Hémostase, CHU Dijon Bourgogne, Dijon, France

  • Nicolas Gendron 

    5   Service d'Hématologie Biologique, Centre-Université de Paris (APHP.CUP), Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
    6   Paris Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Université Paris Cité, INSERM, Paris, France
    7   F-CRIN, INNOVTE, Saint-Etienne-France

  • Valérie Eschwège 

    8   Service d'Hématologie Biologique, Centre Hospitalier Universitaire de Nancy, France

  • Laetitia Mauge 

    5   Service d'Hématologie Biologique, Centre-Université de Paris (APHP.CUP), Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
    6   Paris Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Université Paris Cité, INSERM, Paris, France
    • on behalf of the French Society on Thrombosis Haemostasis
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Abstract

Although inherited and acquired thrombophilia screening should ideally be performed outside of any direct oral anticoagulant (DOAC) therapy, it is sometimes performed in patients who are anticoagulated. However, DOACs have been shown to interfere with many hemostasis tests, with a risk of false-positive/negative results in lupus anticoagulant testing and overestimation of natural coagulation inhibitor levels, which may lead to misdiagnosis. Devices have been developed to overcome DOAC interference but their role in thrombophilia testing is not clearly established. In this comprehensive review, we provide an in-depth overview of the literature on the impact of DOACs on thrombophilia assays, including lupus anticoagulant testing, antithrombin, protein C, and protein S assessment. DOACs can interfere with the results of thrombophilia testing even at low concentrations; therefore information on current or recently discontinued anticoagulant treatment should be provided when prescribing thrombophilia testing. Data on the usefulness of the most used DOAC removal systems based on activated charcoal to circumvent DOAC interference are heterogeneous. They are summarized in this critical review. Although activated charcoal could be useful to remove DOACs from plasma prior to thrombophilia testing, it may not be completely effective, particularly with apixaban. Hence, and in the light of the available literature, we provide 22 practical proposals for reliable thrombophilia testing and accurate result interpretation in samples from patients receiving DOACs and treated in vitro with activated charcoal.

Keywords

direct oral anticoagulant - lupus anticoagulant - antithrombin - protein C - protein S

Contributions' Statement

G.J., C.F., E.D.M., N.G., V.E., and L.M. reviewed the literature; G.J., C.F., E.D.M., N.G., V.E., and L.M. wrote the manuscript. All authors reviewed the manuscript and approved the submitted version.


Supplementary Material



Publication History

Received: 02 June 2025

Accepted: 03 September 2025

Article published online:
29 September 2025

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