Evaluating DOAC dipstick testing in the management of acute stroke: protocol for a multicentre, prospective, observational registry study
Introduction Direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists for stroke prophylaxis in non-valvular atrial fibrillation. Yet, DOAC use is regarded as a contraindication for intravenous thrombolysis in acute ischaemic stroke. The stratification of patients into ‘on-therapy...
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BMJ Publishing Group
2025-06-01
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| Series: | BMJ Open |
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| author | Philip Choi Helen Dewey Edward Patrick Callaly Peter Shuangyue Tan Emily Schembri Marija Borosak |
| author_facet | Philip Choi Helen Dewey Edward Patrick Callaly Peter Shuangyue Tan Emily Schembri Marija Borosak |
| author_sort | Philip Choi |
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| description | Introduction Direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists for stroke prophylaxis in non-valvular atrial fibrillation. Yet, DOAC use is regarded as a contraindication for intravenous thrombolysis in acute ischaemic stroke. The stratification of patients into ‘on-therapy’ and ‘off-therapy’ categories based on their plasma DOAC concentrations is particularly crucial in the acute phase of stroke when decisions for thrombolysis or anticoagulation reversal are time-sensitive. The novel point-of-care DOAC dipstick assay (DOASENSE) rapidly assesses urine for clinically significant DOAC levels, potentially broadening eligibility for thrombolysis or targeted reversal therapy. This multicentre prospective observational registry study aims to evaluate the accuracy and clinical utility of DOAC dipstick testing compared with plasma DOAC assays in acute stroke management across regional Australian hospitals.Methods and analysis This multicentre, prospective, observational study will enrol participants presenting to hospitals across Victoria and Tasmania with acute ischaemic stroke or intracerebral haemorrhage with DOAC ingestion within 48 hours of presentation. Plasma DOAC concentrations measured by chromogenic assays will be compared with rapid urine dipstick results from DOASENSE testing. There is a target sample size of 146 participants. The primary outcomes are as follows: (1) proportion of ischaemic stroke participants with off-therapy plasma DOAC levels and (2) eligibility for reperfusion therapy based on DOASENSE and plasma DOAC concentrations. Secondary outcomes are follows: (1) ischaemic stroke aetiology for participants with on-therapy vs off-therapy DOAC levels; (2) proportion of participants meeting criteria for pharmacological DOAC reversal based on DOASENSE outcomes; (3) incidence of false-negative and false positive DOASENSE results in clinically significant DOAC plasma concentrations at a threshold of ≥30 ng/mL and (4) an exploratory analysis of any false negative DOASENSE assays to identify potential contributing factors.Ethics and dissemination Ethics approval has been granted by the Eastern Health Human Research Ethics Committee (reference number: 99628). Dissemination of findings will occur through peer-reviewed publications and academic conferences. |
| format | Article |
| id | doaj-art-4d39f9b77ad741eeaf2fb276f39b5976 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-4d39f9b77ad741eeaf2fb276f39b59762025-08-20T03:44:18ZengBMJ Publishing GroupBMJ Open2044-60552025-06-0115610.1136/bmjopen-2025-102092Evaluating DOAC dipstick testing in the management of acute stroke: protocol for a multicentre, prospective, observational registry studyPhilip Choi0Helen Dewey1Edward Patrick Callaly2Peter Shuangyue Tan3Emily Schembri4Marija Borosak5Department of Neurosciences, Eastern Health, Box Hill, Victoria, AustraliaDepartment of Neurosciences, Eastern Health, Box Hill, Victoria, AustraliaDepartment of Neurosciences, Eastern Health, Box Hill, Victoria, AustraliaDepartment of Neurosciences, Alfred Health, Melbourne, Victoria, AustraliaMonash University Eastern Health Clinical School, Box Hill, Victoria, AustraliaDepartment of Haematology, Eastern Health, Box Hill, Victoria, AustraliaIntroduction Direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists for stroke prophylaxis in non-valvular atrial fibrillation. Yet, DOAC use is regarded as a contraindication for intravenous thrombolysis in acute ischaemic stroke. The stratification of patients into ‘on-therapy’ and ‘off-therapy’ categories based on their plasma DOAC concentrations is particularly crucial in the acute phase of stroke when decisions for thrombolysis or anticoagulation reversal are time-sensitive. The novel point-of-care DOAC dipstick assay (DOASENSE) rapidly assesses urine for clinically significant DOAC levels, potentially broadening eligibility for thrombolysis or targeted reversal therapy. This multicentre prospective observational registry study aims to evaluate the accuracy and clinical utility of DOAC dipstick testing compared with plasma DOAC assays in acute stroke management across regional Australian hospitals.Methods and analysis This multicentre, prospective, observational study will enrol participants presenting to hospitals across Victoria and Tasmania with acute ischaemic stroke or intracerebral haemorrhage with DOAC ingestion within 48 hours of presentation. Plasma DOAC concentrations measured by chromogenic assays will be compared with rapid urine dipstick results from DOASENSE testing. There is a target sample size of 146 participants. The primary outcomes are as follows: (1) proportion of ischaemic stroke participants with off-therapy plasma DOAC levels and (2) eligibility for reperfusion therapy based on DOASENSE and plasma DOAC concentrations. Secondary outcomes are follows: (1) ischaemic stroke aetiology for participants with on-therapy vs off-therapy DOAC levels; (2) proportion of participants meeting criteria for pharmacological DOAC reversal based on DOASENSE outcomes; (3) incidence of false-negative and false positive DOASENSE results in clinically significant DOAC plasma concentrations at a threshold of ≥30 ng/mL and (4) an exploratory analysis of any false negative DOASENSE assays to identify potential contributing factors.Ethics and dissemination Ethics approval has been granted by the Eastern Health Human Research Ethics Committee (reference number: 99628). Dissemination of findings will occur through peer-reviewed publications and academic conferences.https://bmjopen.bmj.com/content/15/6/e102092.full |
| spellingShingle | Philip Choi Helen Dewey Edward Patrick Callaly Peter Shuangyue Tan Emily Schembri Marija Borosak Evaluating DOAC dipstick testing in the management of acute stroke: protocol for a multicentre, prospective, observational registry study BMJ Open |
| title | Evaluating DOAC dipstick testing in the management of acute stroke: protocol for a multicentre, prospective, observational registry study |
| title_full | Evaluating DOAC dipstick testing in the management of acute stroke: protocol for a multicentre, prospective, observational registry study |
| title_fullStr | Evaluating DOAC dipstick testing in the management of acute stroke: protocol for a multicentre, prospective, observational registry study |
| title_full_unstemmed | Evaluating DOAC dipstick testing in the management of acute stroke: protocol for a multicentre, prospective, observational registry study |
| title_short | Evaluating DOAC dipstick testing in the management of acute stroke: protocol for a multicentre, prospective, observational registry study |
| title_sort | evaluating doac dipstick testing in the management of acute stroke protocol for a multicentre prospective observational registry study |
| url | https://bmjopen.bmj.com/content/15/6/e102092.full |
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