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Table 3 Effect of different DOACs in commonly used LA assays. Adapted from references [45, 46, 48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64]

From: Antiphospholipid Syndrome Committee of the Brazilian Society of Rheumatology position statement on the use of direct oral anticoagulants (DOACs) in antiphospholipid syndrome (APS)

Reference DOAC Tests analyzed Results
Merriman (2010) Rivaroxaban aPTT (Triniclot), aPTT (STAClot), dRVVT (screen, confirm and ratio), Kaolin, DTT False positive dRVVT ratio (88.9%) - all other tests negative / normalization of LA after discontinuation in all but one patient
van Os (2011) Rivaroxaban aPTT (screen PTT-LA and confirm Actin FS), dRVVT (screen LA-1 and confirm LA-2), and snake venom assays (screen TSVT and confirm ECT) False positive dRVVT ratio (40% of SLE w/o aPL became LA positive after rivaroxaban mixing)
Halbmayer (2012) Dabigatran dRVVT (screen, confirm, standard ratio, and normalized ratio) Higher frequency of false positive dRVVT ratio with increasing dabigatran concentrations
Martinuzzo (2014) Rivaroxaban, dabigatran aPTT, dRVVT (screen, confirm, ratio), SCT (screen, confirm, ratio) False positive dRVVT ratio (76.5–100%)
Hillarp (2014) Apixaban aPTT, dRVVT (screen, confirm and ratio) Apixaban did not cause false-positive results
Kim (2014) Dabigatran aPTT (PTT-LA, STAClot-LA) False positive aPTT ratio (50% borderline and 40% positive)
Arachchillage (2015) Rivaroxaban Textarin time, dPT, dRVVT (3 methods: Siemens LA-1/LA-2, HemosIL dRVVT screen and confirm, and in-house dRVVT), TSVT/ECT In vitro: false positive dRVVT ratio by conventional assays, but not in-house assay (90% normal controls and 92% LA-negative APS patients)
Ex vivo: false-positive dRVVT ratio (100%) - remained false-positive at 18 h after the last dose of rivaroxaban
Bonar (2015) Dabigatran dRVVT (screen, STAClot confirm and ratio) False positive dRVVT ratio (in vivo and ex vivo)
Góralczyk (2015) Rivaroxaban aPTT (PTT-LA screen and STAClot confirm), dRVVT (2 methods: HemosIL screen and confirm, and LA-1/LA-2) False positive dRVVT ratio (patients were retested and became LA negative after 24 h of rivaroxaban discontinuation)
Bonar (2016) Rivaroxaban, apixaban dRVVT (screen, STAClot confirm and ratio) False positive dRVVT ratio (rivaroxaban, but not apixaban, caused increased dRVVT ratio ≥ 1.2)
Gosselin (2016) Rivaroxaban, apixaban, and edoxaban dRVVT (3 methods: Siemens LA-1/LA-2, CRYOCheck LA-1/LA-2, dRV-LS/dRV-LR), hexagonal phase (STAClot-LA) False positive dRVVT ratio (for all DOACs)
Pouplard (2016) Rivaroxaban dRVVT (STAClot DRVVT), TSVT/ECT False positive dRVVT ratio; TSVT/ECT was not influenced by rivaroxaban
Ratzinger (2016) Rivaroxaban, apixaban, and dabigatran aPTT, dRVVT False positive dRVVT ratio:
- Dabigatran: 43.3%;
- Rivaroxaban: 30%;
- Apixaban: 20.7% (w/o dose dependent increase).
Antovic (2017) Rivaroxaban, apixaban, and dabigatran aPTT, dRVVT False positive dRVVT ratio (≥1.2):
- Dabigatran: 73%;
- Rivaroxaban: 75%;
- Apixaban: 76%.
Seheult (2017) Rivaroxaban, apixaban, and dabigatran aPTT, dRVVT, TII + PT False positive dRVVT ratio and TTI + PT (aPTT was less affected);
Apixaban was less affected than rivaroxaban;
After rivaroxaban discontinuation, LA positivity dropped from 83 to 26%.
Flieder (2018) Rivaroxaban, apixaban, and dabigatran aPTT, dRVVT (HemosIL and STAClot) False positive dRVVT ratio:
- Dabigatran: 20% (HemosIL) and 71% (STAClot);
- Rivaroxaban: 70% (IL) and 100% (STAClot):
- Apixaban: no influence.
Less important change in aPTT in all DOACs.
Hillarp (2018) Edoxaban dRVVT (Technoclot and STAClot) False positive dRVVT ratio on Technoclot, but not with STAClot
Martinuzzo (2018) Rivaroxaban dRVVT (HemosIL and STAClot) False positive dRVVT ratio (89.2% with HemosIL and 86.2% with STAClot)
Platton (2018) Rivaroxaban and apixaban dRVVT (Siemens LA1 and LA2) dRVVT screen and confirm were falsely increased for both rivaroxaban and apixaban groups. After treatment with DOAC Stop, both dRVVT screen and confirm decreased to normal values.
  1. aPTT activated partial thromboplastin time, DOAC direct oral anticoagulant, dRVVT dilute Russell’s viper venom time, LA lupus anticoagulant, TII + PT thromboplastin inhibition index with prothrombin time, TSVT Taipan snake venom time, ECT Ecarin clotting time