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Cited by 16Systemic Lupus Erythematosus ResearchBlood Coagulation and Thrombosis MechanismsHeparin-Induced Thrombocytopenia and Thrombosis

A Diagnostic Solution for Lupus Anticoagulant Testing in Patients Taking Direct Oral FXa Inhibitors Using DOAC Filter

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Farkh, Carine, Ellouze, Syrine, Gounelle, Louis, Sad Houari, Mama, Duchemin, Jérôme, Proulle, Valérie, Fontenay, Michaela, Delavenne, Xavier +1 more·2021·Frontiers in Medicine
DOI 10.3389/fmed.2021.683357PMC PMC8200390
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Abstract

Background: Direct oral factor Xa (FXa) inhibitors interfere with lupus anticoagulant (LA) assays challenging antiphospholipid syndrome diagnosis in treated patients. We evaluated a new device, called DOAC Filter, and its usefulness in this setting. It is a single-use filtration cartridge in which FXa inhibitor compounds are trapped by non-covalent binding while plasma is filtered through a solid phase. Patient samples were analyzed before and after filtration: 38 rivaroxaban, 41 apixaban, and 68 none. Anticoagulant plasma concentrations were measured using specific anti-Xa assays and HPLC-MS/MS. LA testing was performed using dilute Russell Viper Venom Time (dRVVT) and Silica Clotting Time (SCT). Baseline median [min–max] concentrations were 64.8 [17.6; 311.4] for rivaroxaban and 92.1 ng/mL [37.1; 390.7] for apixaban (HPLC-MS/MS). They were significantly correlated with anti-Xa assay results (r = 0.98 and r = 0.94, respectively). dRVVT was positive in 92% rivaroxaban and 72% apixaban and SCT in 28 and 41% of samples, respectively. Post-filtration, median % of neutralization was 100% with rivaroxaban and apixaban concentrations of, respectively, <2 [<2–2.4] and <2 ng/mL [<2–9.6] using HPLC-MS/MS. No significant effect of DOAC Filter was observed on LA testing in controls (n = 31) and LA-positive (n = 37) non-anticoagulated samples. dRVVT and SCT remained positive in, respectively, 16 and 8% of rivaroxaban and 41 and 18% of apixaban samples. DOAC Filter would be an easy-to-use device allowing FXa inhibitor removal from plasma samples, limiting their interference with LA testing in treated patients.

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  • Both DOAC removal strategies (absorbents and filtration) can provide incomplete drug removal or influence the clotting times, resulting in possible false positives and false negatives in LA testing.

    “Both removal strategies can provide an incomplete drug removal or influence the clotting times, resulting in possible false positives and false negatives in LA testing [81,82,85,86].”

    From Lupus Anticoagulant Detection under the Magnifying Glass (2023) · cites this paper as [86]

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Cited by

Sorted by citations

Authors
Farkh, C., Ellouze, S., Gounelle, L., Sad Houari, M., Duchemin, J., Proulle, V., Fontenay, M., Delavenne, X., & Jourdi, G.
Affiliations
  • Hôpital Cochin (FR)
  • Inserm (FR)
Corresponding author
Jourdi, Georges
ORCID
Venue
Frontiers in Medicine
Publisher
Frontiers Media SA
Published
2021-05-31
Volume
8
Pages
683357-683357
ISSN
2296-858X (ISSN-L)
DOI
10.3389/fmed.2021.683357
PMC
PMC8200390
OpenAlex
W3172342231
Cited by
16
References
3
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 5 · 2021: 3
FWCI
2.64
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
  • Health Sciences › Medicine › Surgery › Heparin-Induced Thrombocytopenia and Thrombosis
Keywords
lupus anticoagulant, rivaroxaban, apixaban, antiphospholipid syndrome, assay interference, plasma filtration, dilute Russell viper venom time, anti-Xa assay

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