Determination of Direct Oral Anticoagulants in Forensic Toxicology

Oral anticoagulants have been used for more than 50 years as antithrombotic agents, particularly in the primary and secondary prophylaxis of thromboembolic disorders. Our study�s purpose is to synthetize and analyze the toxicological methods used to determine the oral anticoagulants, described in the literature, so we can identify the optimal methods, taking into consideration the diversity of forensic medicine workload. In the electronic databases, for the period 1990-2019, there were identified 56 articles that included the searched keywords. Of these, 28 were included in our study. We excluded the articles that were not lining up with the objective of our study, the update-type articles and the case studies. After analyzing the literature, it was observed that liquid chromatography-mass spectrometry is the ideal method for detecting low-dosed drugs, such as oral anticoagulants.

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Determination of dabigatran, rivaroxaban and apixaban by ultra-performance liquid chromatography - tandem mass spectrometry (UPLC-MS/MS) and coagulation assays for therapy monitoring of novel direct oral anticoagulants

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.12702 ◽

2014 ◽

Vol 12 (10) ◽

pp. 1636-1646 ◽

Cited By ~ 87

Author(s):

E. M. H. Schmitz ◽

K. Boonen ◽

D. J. A. van den Heuvel ◽

J. L. J. van Dongen ◽

M. W. M. Schellings ◽

...

Keyword(s):

Mass Spectrometry ◽

Therapy Monitoring ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Ultra Performance Liquid Chromatography ◽

Tandem Mass ◽

Coagulation Assays ◽

Chromatography Tandem Mass Spectrometry ◽

Liquid Chromatography Tandem Mass

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A synergy of liquid chromatography with high‐resolution mass spectrometry and coagulation test for determination of direct oral anticoagulants for clinical and toxicological purposes

Biomedical Chromatography ◽

10.1002/bmc.5195 ◽

2021 ◽

Author(s):

Vítězslav Maier ◽

Luděk Slavík ◽

Peter Ondra

Keyword(s):

Mass Spectrometry ◽

Liquid Chromatography ◽

High Resolution ◽

High Resolution Mass Spectrometry ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Coagulation Test ◽

High Resolution Mass ◽

Resolution Mass

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Detecting direct oral anticoagulants in trauma patients using liquid chromatography–mass spectrometry

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002527 ◽

2020 ◽

Vol 88 (4) ◽

pp. 508-514 ◽

Cited By ~ 1

Author(s):

Sudha Jayaraman ◽

Jonathan H. DeAntonio ◽

Stefan W. Leichtle ◽

Jinfeng Han ◽

Loren Liebrecht ◽

...

Keyword(s):

Mass Spectrometry ◽

Liquid Chromatography ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Trauma Patients ◽

Liquid Chromatography Mass Spectrometry ◽

Chromatography Mass Spectrometry

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Detecting Direct Oral Anticoagulants in Trauma Patients using Liquid Chromatography-Mass Spectrometry: a Novel Approach to Medication Reconciliation

10.1101/651075 ◽

2019 ◽

Author(s):

Sudha Jayaraman ◽

Jonathan H. DeAntonio ◽

Stefan W. Leichtle ◽

Jinfeng Han ◽

Loren Liebrecht ◽

...

Keyword(s):

Mass Spectrometry ◽

Liquid Chromatography ◽

Medication Reconciliation ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

False Negative ◽

Trauma Patients ◽

Liquid Chromatography Mass Spectrometry ◽

Predictive Values ◽

Chromatography Mass Spectrometry

AbstractBackgroundAccurate medication reconciliation in trauma patients is essential but difficult. Currently there is no established clinical method of detecting direct oral anticoagulants (DOACs) in trauma patients. We hypothesized that a liquid chromatography-mass spectrometry (LCMS) based assay can be used to accurately detect DOACs in trauma patients upon hospital arrival.MethodsPlasma samples were collected from 356 patients who provided informed consent including-10 healthy controls, 19 known positive or negative controls and 327 trauma patients over 65 years of age who were evaluated at our large, urban Level 1 Trauma Center. The assay methodology was developed in healthy and known controls to detect apixaban, rivaroxaban and dabigatran using LCMS and then applied to 327 samples from trauma patients. Standard medication reconciliation processes in the electronic medical record documenting DOAC usage was compared with LCMS results to determine overall accuracy, sensitivity, specificity and positive and negative predictive values (PPV, NPV) of the assay.ResultsOf 356 patients, 39 were on DOACs (10.96%): 21 were on Apixaban, 14 on rivaroxaban and 4 on dabigatran. The overall accuracy of the assay for detecting any DOAC was 98.60%, with a sensitivity of 94.87% and specificity of 99.06%, (PPV 92.50% and NPV 99.37%). The assay detected apixaban with a sensitivity of 90.48% and specificity of 99.11% (PPV 86.36% and NPV 99.40%). There were three false positive results and two false negative LCMS results for apixaban. Dabigatran and rivaroxaban were detected with 100% sensitivity and specificity.ConclusionsThis LCMS-based assay was highly accurate in detecting DOACs in trauma patients. Further studies need to confirm the clinical efficacy of this LCMS assay and its value for medication reconciliation in trauma patients.Study type: diagnostic testBasic Science paper: therefore does not require a level of evidence.

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