Objective Assessment of the anticoagulant effect of direct oral anticoagulants (DOACs) still
is a challenge for various medical disciplines, especially in patients needing immediate
care in a medical emergency. Aside from severe bleeding and thrombotic events, evaluation
of the coagulation status is important for urgent indication of fracture care or administration
of a specific antidot. An assay that screens for the absence of a DOAC might help
accelerate treatment in these situations. The goal of this study is to evaluate the
use of a qualitative POC Method (DOAC Dipstick, DOASENSE®) in an emergency setting.
Material and Methods Between 11/2019 and 04/2020 the POC method was available for all clinicians in a
level I emergency department. The POC testing was indicated by the physician on duty
followed by a standardized questionnaire on basic patients’ parameters, indication
for the qualitative testing and drawn conclusions based on the tests´ results. Intraindividual
reliability blinded to the clinical user (visual testing vs. semiquantitative reader)
as well as the interindividual reliability compared with standard anti-factor-Xa (antiXa)-
or direct-thrombin-inhibitor (DTI)-tests were investigated.
Results In total, 82 patients were included (30 % Neurology, 50 % Trauma, 10 % Neurosurgery,
10 % Internal Medicine) 28 patients being anticoagulated with antiXa inhibitor and
7 patients with dabigatran. Test results of POC testing could be confirmed using standard
anti-factor-Xa (antiXa)- or direct-thrombin-inhibitor (DTI)-tests in all cases. In
most cases the POC test was used to identify unknown DOAC status in patients who could
not be interviewed concerning their medication. 12 patients received a lysis therapy
after exclusion of DOAC anticoagulation, 2 patients were treated with a specific antidot
after a major bleeding event. In 6 patients the POC test demonstrated a positive result
in patients that stopped using the oral medication several days ago.
Conclusion In an emergency with an immediate consequence under time pressure, the POC test might
provide a significant time advantage compared to standard laboratory testing. Due
to the cumulative effect within the patients´ urine the test can only be used for
the qualitative verification and does not provide any information concerning the actual
anticoagulative effect.
