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

Georges Jourdi; Claire Flaujac; Emmanuel De Maistre; Nicolas Gendron; Valérie Eschwège; Laetitia Mauge; on behalf of the French Society on Thrombosis Haemostasis

doi:10.1055/a-2695-2674

Thrombosis and Haemostasis, Table of Contents

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

¹Service d'Hématologie Biologique, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris Nord (APHP.Nord), Paris, France

²Université Paris Cité, INSERM, UMRS-1144, Optimisation Thérapeutique en Neuropharmacologie, Paris, France
Claire Flaujac

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

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

⁵Service d'Hématologie Biologique, Centre-Université de Paris (APHP.CUP), Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France

⁶Paris Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Université Paris Cité, INSERM, Paris, France

⁷F-CRIN, INNOVTE, Saint-Etienne-France
Valérie Eschwège

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

⁵Service d'Hématologie Biologique, Centre-Université de Paris (APHP.CUP), Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France

⁶Paris Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Université Paris Cité, INSERM, Paris, France

on behalf of the French Society on Thrombosis Haemostasis

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

Full Text

References

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