{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:50:40Z","timestamp":1792788640617,"version":"4.5.0"},"reference-count":39,"publisher":"Walter de Gruyter GmbH","issue":"11","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"E.C. Noyons Foundation","id":[{"id":"https:\/\/ror.org\/02pwxx534","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2026-0026_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Fast estimations of direct oral anticoagulant (DOAC) plasma concentrations are useful in ruling out clinically significant concentrations before urgent surgical interventions. DOAC-specific anti-factor Xa (anti-Xa) assays are time consuming and not available 24\/7 in most hospitals. Anti-Xa assays calibrated with low-molecular weight heparins (LMWHs) are widely available 24\/7 and could give concentration estimations for anti-Xa DOACs (DXaIs). This study aimed to determine whether LMWH-calibrated anti-Xa assays could establish thresholds corresponding to DXaI concentrations associated with non-increased bleeding\u00a0risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0026_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Omniplasma was spiked with rivaroxaban, apixaban, or edoxaban in a 5\u2013604\u202fng\/mL range. One pooled patient sample was included per DXaI. Samples were analysed in 18 hospital laboratories, using 5 different analyser-reagent combinations (Stago Liquid anti-Xa on STA-R Max2\/3, HemosIL Liquid anti-Xa on ACL-TOP350\/550, Innovance Heparin on CS2500\/CN3000, Biophen Heparin LRT on CS2500\/CS5100, Roche anti-Xa on Cobas t511 analysers). Samples were analysed using local LMWH anti-Xa assay protocols using local reagent lots. Delta optical density and \u201cLMWH\u201d anti-Xa-activity were reported. DXaI concentrations were confirmed using liquid chromatography with tandem mass spectrometry detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0026_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Large differences in DXaI sensitivity between reagent groups were observed, which prevent formulation of universal threshold values for non-increased risk of bleeding. However, reagent-specific threshold values can be established with the exception of the Hyphen reagent group, due to high interlaboratory variability. Within analyser-reagent groups, a good correlation between spiked DXaI concentrations and \u201cLMWH\u201d activity assay readout is observed, permitting conversion between the two units up to 75\u202fng\/mL for all DXaIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2026-0026_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Widely available rapid low-to-moderate DXaI concentration estimation can be achieved using LMWH-calibrated anti-Xa assays. Potential applications include ruling out clinically relevant DXaI concentrations before surgery and screening for the presence of a factor Xa inhibitor, but not specific DXaI monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2026-0026","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T03:56:43Z","timestamp":1781841403000},"page":"2590-2601","source":"Crossref","is-referenced-by-count":0,"title":["Reagent-specific anti-Xa DOAC safety cutoffs can be established using multiple LMWH-calibrated anti-Xa assays"],"prefix":"10.1515","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9054-5695","authenticated-orcid":false,"given":"Thomas","family":"Nieuwenstein","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine , Laboratory of Hematology, Radboudumc , Nijmegen , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan P.","family":"Stoffer","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , Radboudumc Laboratory for Diagnostics, Radboudumc , Nijmegen , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave L.S.","family":"Hellenbrand","sequence":"additional","affiliation":[{"name":"Central Diagnostics Laboratory, MUMC+ , Maastricht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8401-0879","authenticated-orcid":false,"given":"Ron A.A.","family":"Math\u00f4t","sequence":"additional","affiliation":[{"name":"Department of Hospital Pharmacy , Amsterdam University Medical Center\u00a0\u2013\u00a0Location AMC , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5538-1806","authenticated-orcid":false,"given":"Lucas J.","family":"van Pelt","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , University Medical Center Groningen , Groningen , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie C.V.","family":"P\u00e9qu\u00e9riaux","sequence":"additional","affiliation":[{"name":"Laboratory Clinical Chemistry and Hematology, Jeroen Bosch Ziekenhuis , Den Bosch , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0126-4695","authenticated-orcid":false,"given":"Daan","family":"van de Kerkhof","sequence":"additional","affiliation":[{"name":"General Clinical Laboratory, Catharina Ziekenhuis , Eindhoven , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8300-6365","authenticated-orcid":false,"given":"Philip H.M.","family":"Kuijper","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, M\u00e1xima Medical Center , Veldhoven , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janneke C.","family":"Zant","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , Noordwest Ziekenhuisgroep , Alkmaar , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique A.J.","family":"Garnier","sequence":"additional","affiliation":[{"name":"Clinical Chemistry and Haematology, Reinier Haga MDC , Delft , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2151-6287","authenticated-orcid":false,"given":"Roger K.","family":"Schindhelm","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , Diagnost-IQ , Zaandam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6544-2331","authenticated-orcid":false,"given":"Henrike M.","family":"Hamer","sequence":"additional","affiliation":[{"name":"Laboratory Specialized Diagnostics & Research, Department of Laboratory Medicine , Amsterdam UMC , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans L.P.","family":"van Duijnhoven","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Elkerliek Ziekenhuis , Helmond , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu C.J.","family":"Bosman","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry, Hematology & Immunology , Diakonessenhuis , Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen H.","family":"Jeninga","sequence":"additional","affiliation":[{"name":"Clinical Chemical Hematology Laboratory, Tergooi Medical Center , Hilversum , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8166-4275","authenticated-orcid":false,"given":"Jacques B.","family":"de Kok","sequence":"additional","affiliation":[{"name":"Laboratory Clinical Chemistry, Deventer Ziekenhuis , Deventer , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0983-7532","authenticated-orcid":false,"given":"Mark W.M.","family":"Schellings","sequence":"additional","affiliation":[{"name":"Laboratory Clinical Chemistry, Maasstad Ziekenhuis , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7780-1920","authenticated-orcid":false,"given":"Lenneke","family":"Waals-Prinzen","sequence":"additional","affiliation":[{"name":"Result Laboratorium , Breda , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1593-424X","authenticated-orcid":false,"given":"Sanna R.","family":"Rijpma","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , Laboratory of Hematology, 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