PB1087 - Rapid Detection of Exposure to Direct Oral Anticoagulants (DOACs): A Qualitative Urinary Dipstick Point-of-Care Assay

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Marina Marchetti, PhD

Hematologist
Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
Bergamo, Lombardia, Italy

Co-Author(s)

CA

Chiara Ambaglio

MD
Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy
ES

Eleonora Sanga

Hospital laboratory technician
ASST Papa Giovanni XXIII Bergamo, Italy
Bergamo, Lombardia, Italy
LB

Luca Barcella

MD
Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy
FS

Francesca Schieppati

MD
Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
Bergamo, Lombardia, Italy
AF

Anna Falanga

Professor of Hematology
ASST Papa Giovanni XXIII Bergamo and University of Milan Bicocca, Italy
Bergamo, Lombardia, Italy
JH

Job Harenberg

Professor of Medicine
Ruprecht Karls University of Heidelberg
Heidelberg, Baden-Wurttemberg, Germany

Background: Knowing whether a patient has been recently exposed to DOAC is a very important issue in the emergency setting for rapid clinical decisions. The DOASENSE Dipstick rapidly detects the presence of DOACs in urine, discriminating between direct factor Xa or thrombin inhibitors.

Aims: To evaluate the operativity of the DOASENSE Dipstick to implement its use in the Emergency Medicine Service at our Hospital.

Methods: Patients on DOAC referred to our thrombosis and hemostasis outpatient clinic were included. Comorbidities and concomitant therapies were recorded. Subjects not taking DOACs or on LMWH were included as controls. Venous blood and urine samples were collected at valley and/or peak of DOAC concentration. Urine qualitative detection of DOAC was performed using the DOASENSE Dipsticks and the DOASENSE Reader, while DOAC plasma concentration by specific tests on a Stago STA-R Max® instrumentation.

Results: A group of 27 patients (21M/6F) with a median age of 69 years (range:22-88) were studied: 9 were on rivaroxaban, 7 on dabigatran, 6 on edoxaban, and 5 on apixaban. In samples collected at valley (n= 19), the drug was clearly detected in urine of 18 patients, also in the presence of very low plasma drug concentration (range: 4 – 211 ng/ml). The urine of one patient on rivaroxaban tested negative and the corresponding plasma value was 0 ng/ml. Urine collected at peak (n=18) were all positive for DOAC (plasma concentrations: 54 – 630 ng/ml). All plasma and urine samples from subjects not on DOACs tested negative, including those on LMWH. Results from the visual analysis of the pads were 100% in agreement with that provided by reader

Conclusion(s): Our study confirmed the reliability of the urine determination of DOACs by the DOASENSE tool, further supporting its utility at an emergency unit for screening patients with severe bleeding, and/or thrombotic events, or before urgent major surgical interventions.