From the Literature

 

Published: Nov 2019

Accuracy of a rapid diagnostic test for the presence of direct oral factor Xa or thrombin inhibitors in urine – a multicenter trial.
Harenberg J, Beyer-Westendorf J, Crowther M, et al.
Thromb Haemost 2019; Nov 8 [Epub ahead of print].
Pub Med
NATA rating :

 

REVIEW by:
C.-M. Samama

 

NATA REVIEW:
Harenberg et al. have developped a rapid colorimetric point-of-care test using patient urine sample that is able to detect direct oral anticoagulants. In this multicentre study (880 evaluable patients), factor Xa inhibitors (apixaban, edoxaban, rivaroxaban) and the thrombin inhibitor dabigatran were detected with a high sensitivity, specificity and accuracy (>95% correct positive and negative predictive results).

This test may be of great help in daily clinical practice, as demonstrated by the authors. In a patient presenting with a major haemorrhage, a negative DOAC Dipstick test result indicates that DOACs are highly unlikely to contribute to the bleeding event. If the DOAC Dipstick test result is positive, a specific antidote can be considered immediately or after plasma DOAC levels have been determined.

If a patient treated with a DOAC requires an urgent major operative procedure, a negative DOAC Dipstick test shows that it is unlikely that the patient has significant DOAC concentrations in blood, and the operative procedure may be performed as soon as indicated. If the DOAC Dipstick test is positive, the operation may need to be postponed or additional blood tests should be performed to guide the decision process.

Indeed, the test does not enable precise quantification of DOAC levels; the rating scale for both for the factor Xa and thrombin inhibitor pads contains the following possibilities: negative, positive +, and positive ++ . Nevertheless, this test is really promising and the study meets international standards. For sure, it will be integrated into laboratory and clinical decision-making processes and will improve patient care.


– Charles-Marc Samama