DOAC-Remove to counteract the interference of anti-Xa oral anticoagulants on the monitoring of heparin

IF 2.2 4区医学 Q3 HEMATOLOGY

International Journal of Laboratory Hematology Pub Date : 2024-05-27 DOI:10.1111/ijlh.14321

Sophie Melicine, Capucine Habay, Wiame Ghammad, Julie Carré, Jean Luc Diehl, David M. Smadja, Nicolas Gendron, Dominique Helley, Laetitia Mauge

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引用次数: 0

Abstract

Introduction

The monitoring of unfractionated heparin (UFH) by anti-factor Xa activity (AXA) is commonly used to ensure effective anticoagulation and prevent bleeding risk. However, in patients previously treated with an anti-Xa direct oral anticoagulant (DOAC) switching to UFH therapy, there is a risk of interference that may lead to inappropriate anticoagulation. The first objective of this study was to validate DOAC-Remove to remove DOAC for measuring UFH specific AXA. The second objective was to assess the length of DOAC interference on UFH monitoring and to identify potential predictive factors.

Materials and Methods

This monocentric retrospective study included all patients admitted from April 2019 to April 2021 previously treated with anti-Xa DOAC, and for whom an interference on UFH monitoring was suspected. Interference was defined as a difference in the AXA measured before and after using DOAC-Remove >2.8-fold standard deviation of the method.

Results

Removal with DOAC-Remove was specific of DOAC (apixaban n = 42, rivaroxaban n = 41, UFH n = 20) and sufficient to avoid interference on UFH AXA measurement. The exact interference length was 6.0 days [IQR 3.0–11.0] for apixaban (n = 26) and 4.5 days [IQR 2.0–5.8] for rivaroxaban (n = 20). Among the 89 patients sorted based on an interference length ≤ or >3 days, 74 (83.1%) presented an interference greater than 3 days. Correlations were observed with age for apixaban and creatinine for rivaroxaban.

Conclusions

Our results suggest that DOAC-Remove could be of high interest in patients receiving UFH previously treated with an anti-Xa DOAC even if DOAC was stopped for more than 3 days.

查看原文本刊更多论文

DOAC-Remove 可抵消抗 Xa 口服抗凝剂对肝素监测的干扰。

简介：通过抗 Xa 因子活性（AXA）监测非静脉曲张肝素（UFH）是确保有效抗凝和预防出血风险的常用方法。然而，对于之前接受过抗 Xa 直接口服抗凝剂（DOAC）治疗的患者来说，转而接受 UFH 治疗可能会受到干扰，从而导致不适当的抗凝治疗。本研究的第一个目标是验证 DOAC-Remove 是否能去除 DOAC 以测量 UFH 特异性 AXA。第二个目标是评估 DOAC 对 UFH 监测的干扰时间，并确定潜在的预测因素：这项单中心回顾性研究纳入了2019年4月至2021年4月期间收治的所有曾接受抗Xa DOAC治疗并怀疑干扰UFH监测的患者。干扰的定义是使用 DOAC-Remove 前后测得的 AXA 差异大于方法标准偏差的 2.8 倍：使用DOAC-Remove去除DOAC（阿哌沙班42例，利伐沙班41例，UFH 20例）的特异性，足以避免对UFH AXA测量的干扰。阿哌沙班（26 例）和利伐沙班（20 例）的确切干扰时间分别为 6.0 天 [IQR 3.0-11.0] 和 4.5 天 [IQR 2.0-5.8]。在根据干扰时间≤或大于 3 天进行分类的 89 例患者中，有 74 例（83.1%）的干扰时间大于 3 天。阿哌沙班的干扰与年龄有关，利伐沙班的干扰与肌酐有关：我们的研究结果表明，即使 DOAC 停药超过 3 天，DOAC-Remove 对接受 UFH 治疗的患者仍有很大意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Laboratory Hematology 医学-血液学

CiteScore

4.50

自引率

6.70%

发文量

211

审稿时长

6-12 weeks

期刊介绍： The International Journal of Laboratory Hematology provides a forum for the communication of new developments, research topics and the practice of laboratory haematology. The journal publishes invited reviews, full length original articles, and correspondence. The International Journal of Laboratory Hematology is the official journal of the International Society for Laboratory Hematology, which addresses the following sub-disciplines: cellular analysis, flow cytometry, haemostasis and thrombosis, molecular diagnostics, haematology informatics, haemoglobinopathies, point of care testing, standards and guidelines. The journal was launched in 2006 as the successor to Clinical and Laboratory Hematology, which was first published in 1979. An active and positive editorial policy ensures that work of a high scientific standard is reported, in order to bridge the gap between practical and academic aspects of laboratory haematology.