DOASENSE in Acute Stroke: Why Point-of-Care DOAC Testing Is Changing the Game

The Challenge

For patients presenting with acute ischaemic stroke, time is brain. The decision to administer thrombolysis must be made within a narrow window — and for patients taking direct oral anticoagulants (DOACs), that decision has historically been complicated by one critical question: how much anticoagulant is on board right now?

Standard laboratory DOAC plasma testing takes 45–60 minutes — often too slow to inform a timely thrombolysis decision. As a result, many clinicians default to excluding DOAC patients from thrombolysis based on medication history alone. But research now shows this approach is leaving eligible patients untreated.

The Missed Opportunity

Studies show that up to 40% of patients presenting with acute stroke while on a DOAC actually have plasma levels low enough to safely receive thrombolysis — yet they are being excluded based on history rather than measurement.

This is a significant and avoidable gap in care.

The Solution: DOASENSE

DOASENSE is a point-of-care urine dipstick test that detects clinically significant DOAC levels at the bedside — in approximately 10 minutes, with no blood draw required.

Key features:

• 🧪 Urine-based — simple, non-invasive sample collection

• ⚡ Result in ~10 minutes — within the thrombolysis decision window

• 📍 Bedside use — no laboratory or specialist equipment needed

• ✅ 95% correlation with plasma DOAC levels

• 🔒 High negative predictive value — a negative DOASENSE result reliably rules out clinically significant DOAC levels, giving clinicians the confidence to proceed with thrombolysis

• 🎯 Zero false negatives in hyperacute stroke patients (Monash pilot study)

Growing Australian Evidence

The evidence base for DOASENSE in stroke is growing rapidly — and Australia is at the forefront.

A multicentre prospective study across Victoria and Tasmania is currently underway, evaluating DOASENSE specifically in regional Australian hospitals using the Victorian telemedicine stroke service. With 146 participants across sites where rapid decision-making is critical, this trial is building the local evidence base needed to support wider adoption.

The landmark Monash University pilot study (2023) demonstrated:

• 95% agreement between DOASENSE and plasma DOAC levels

• Result available in 20 minutes vs 52 minutes for lab testing

• High negative predictive value — making it particularly powerful as a rule-out tool in the acute setting

• Zero false negatives in the acute stroke cohort

A further European multicentre validation study (2025) confirmed its accuracy and clinical utility across multiple stroke centres.

What This Means for Your Stroke Service

DOASENSE enables a simple, evidence-based workflow:

1. Patient on DOAC presents to ED

2. Urine dipstick performed at bedside

3. DOASENSE result available in ~10 minutes

4. Negative result = clinically significant DOAC levels ruled out → proceed to thrombolysis with confidence

5. Eligible patients treated without delay

For regional and metropolitan hospitals alike, this means fewer patients missed, faster treatment, and better outcomes.