{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:22:20Z","timestamp":1791235340629,"version":"4.1.0"},"reference-count":95,"publisher":"Georg Thieme Verlag KG","issue":"09","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Although inherited and acquired thrombophilia screening should ideally be performed outside of any direct oral anticoagulant (DOAC) therapy, it is sometimes performed in patients who are anticoagulated. However, DOACs have been shown to interfere with many hemostasis tests, with a risk of false-positive\/negative results in lupus anticoagulant testing and overestimation of natural coagulation inhibitor levels, which may lead to misdiagnosis. Devices have been developed to overcome DOAC interference but their role in thrombophilia testing is not clearly established. In this comprehensive review, we provide an in-depth overview of the literature on the impact of DOACs on thrombophilia assays, including lupus anticoagulant testing, antithrombin, protein C, and protein S assessment. DOACs can interfere with the results of thrombophilia testing even at low concentrations; therefore information on current or recently discontinued anticoagulant treatment should be provided when prescribing thrombophilia testing. Data on the usefulness of the most used DOAC removal systems based on activated charcoal to circumvent DOAC interference are heterogeneous. They are summarized in this critical review. Although activated charcoal could be useful to remove DOACs from plasma prior to thrombophilia testing, it may not be completely effective, particularly with apixaban. Hence, and in the light of the available literature, we provide 22 practical proposals for reliable thrombophilia testing and accurate result interpretation in samples from patients receiving DOACs and treated in vitro with activated charcoal.<\/jats:p>","DOI":"10.1055\/a-2695-2674","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T23:05:29Z","timestamp":1759187129000},"page":"867-882","source":"Crossref","is-referenced-by-count":3,"title":["Usefulness and Limits of DOAC Removal Agents Based on Activated Charcoal in Thrombophilia Testing: Literature Review and Expert Proposals"],"prefix":"10.1055","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8738-5975","authenticated-orcid":false,"given":"Georges","family":"Jourdi","sequence":"additional","affiliation":[{"name":"Service d'H\u00e9matologie Biologique, H\u00f4pital Lariboisi\u00e8re, Assistance Publique H\u00f4pitaux de Paris Nord (APHP.Nord), Paris, France"},{"name":"Universit\u00e9 Paris Cit\u00e9, INSERM, UMRS-1144, Optimisation Th\u00e9rapeutique en Neuropharmacologie, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3662-3416","authenticated-orcid":false,"given":"Claire","family":"Flaujac","sequence":"additional","affiliation":[{"name":"Laboratoire de Biologie M\u00e9dicale (Secteur H\u00e9mostase), Centre Hospitalier de Versailles - H\u00f4pital Andr\u00e9 Mignot, Le Chesnay-Rocquencourt, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3459-7397","authenticated-orcid":false,"given":"Emmanuel","family":"De Maistre","sequence":"additional","affiliation":[{"name":"Laboratoire d'H\u00e9mostase, CHU Dijon Bourgogne, Dijon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4852-4738","authenticated-orcid":false,"given":"Nicolas","family":"Gendron","sequence":"additional","affiliation":[{"name":"Service d'H\u00e9matologie Biologique, Centre-Universit\u00e9 de Paris (APHP.CUP), H\u00f4pital Europ\u00e9en Georges Pompidou, Assistance Publique H\u00f4pitaux de Paris, Paris, France"},{"name":"Paris Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Universit\u00e9 Paris Cit\u00e9, INSERM, Paris, France"},{"name":"F-CRIN, INNOVTE, Saint-Etienne-France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9057-9295","authenticated-orcid":false,"given":"Val\u00e9rie","family":"Eschw\u00e8ge","sequence":"additional","affiliation":[{"name":"Service d'H\u00e9matologie Biologique, Centre Hospitalier Universitaire de Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3946-2312","authenticated-orcid":false,"given":"Laetitia","family":"Mauge","sequence":"additional","affiliation":[{"name":"Service d'H\u00e9matologie Biologique, Centre-Universit\u00e9 de Paris (APHP.CUP), H\u00f4pital Europ\u00e9en Georges Pompidou, Assistance Publique H\u00f4pitaux de Paris, Paris, France"},{"name":"Paris Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Universit\u00e9 Paris Cit\u00e9, INSERM, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the French Society on Thrombosis Haemostasis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"issue":"S 01","key":"ref1","first-page":"e1","article-title":"[Recommendations for best practice in the management of venous thromboembolic disease in adults. 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