Here’s a provocative question from Sacha N. Uljon, MD, PhD, Medical Director, Massachusetts General Brigham Special Coagulation Integrated Laboratory Service:
Hello, this post is about lab findings in apixaban overdose. We have now seen two suicide attempts involving apixaban. There was no clot at all on the PT/PTT (Werfen/Hemosil), so the anti-Xa level can’t be obtained. We can’t result it as “>” because there is no result. There is no HIL interference. How do I know it’s the DOAC? Offline treatment with DOAC-stop leaves some anti-Xa signal, but near-complete normalization of PT/PTT. In both cases, clots were not obtained for days after overdose.
Has anyone with Stago or Siemens seen this situation? I am interested to hear if this is a reagent-specific issue and whether others could get clots in such specimens. We ended up resulting the DOAC-stopped values with a huge disclaimer, but this is non-ideal from a medical-legal point of view. If it’s reagent specific, I’m thinking of bringing back the Stago PT/PTT offline for these cases. Sacha.
Here’s a 10-23-26 response from Paul Riley, PhD, MBA, Scientific Market Development Manager, Diagnostica Stago:
George spoke with a colleague and coagulation expert Dave McGlasson, MS, MLS, who indicated that, regrettably, the DOAC-Dipstick, which accurately detects urine DOACs, is not FDA-approved and is not marketed in the USA.
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