BACKGROUND:Direct oral anticoagulants (DOACs) are increasingly prescribed for the prevention and treatment of thrombosis. However, DOACs are associated with extensive interference in coagulation assays. Herein, we evaluate raw activated charcoal (AC) as an adsorbent material, to minimise DOAC-associated interferences in routine and specialised coagulation parameters on CS-series analysers (Sysmex, Kobe, Japan).METHODS:Commercial human-derived non-anticoagulated plasma materials, with or without increasing concentrations of anticoagulant, were assayed for routine and specialised coagulation parameters before and after treatment with AC.RESULTS:Treatment of non-anticoagulated plasma with raw AC had minimal impact on routine and specialised coagulation parameters available on the CS-series; however, clinically relevant prolongations of certain activated partial thromboplastin time (APTT)-based assays were observed after treatment. Furthermore, in apixaban- and rivaroxaban-containing plasma material, AC efficiently adsorbed therapeutic and supratherapeutic DOAC concentrations; and, treatment with raw AC resolved DOAC-associated interferences on all affected routine and specialised coagulation parameters.CONCLUSIONS:Overall, raw AC efficiently adsorbed apixaban and rivaroxaban from human-derived plasma, without significantly affecting the majority of underlying routine and specialised coagulation parameters available on CS-series analysers.

We read with interest the recent International Society on Thrombosis and Haemostasis Scientific and Standardization Committee communication regarding the challenges in the management of women with type 2b von Willebrand disease during pregnancy [ [1] Miljic P. Noureldin A. Lavin M. Kazi S. Sanchez-Luceros A. James P.D. Othman M. Challenges in the management of women with type 2B von Willebrand disease durig pregnancy and the postpartum period:evidence from literature, and data from an international registry and physicians’ survey –communication from the Scientific and Standardization Committees of the International Society on Thrombosis and Haemostasis. J Throb Haemost. 2023; 21: 154-163 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ]. This is a difficult situation to manage given the dynamic nature of hemostatic parameters during pregnancy and the paucity of cases.