Measurement of Anticoagulation in Patients on Dabigatran, Rivaroxaban and Apixaban Therapy by Novel Automated Thrombelastography
Background: Direct-acting oral anticoagulants (DOACs) do not require monitoring. Measurement of DOAC effect would be useful in the event of bleeding, trauma, and thromboembolism while on anticoagulation. We evaluated the effectiveness of the investigational DOAC assays on the TEG®6s Hemostasis Analy...
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Georg Thieme Verlag KG
2021
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oai:doaj.org-article:a579f2aee73f467a8bd1e62b2bbf4b462021-11-09T23:56:14ZMeasurement of Anticoagulation in Patients on Dabigatran, Rivaroxaban and Apixaban Therapy by Novel Automated Thrombelastography2512-946510.1055/a-1692-1415https://doaj.org/article/a579f2aee73f467a8bd1e62b2bbf4b462021-11-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/a-1692-1415https://doaj.org/toc/2512-9465Background: Direct-acting oral anticoagulants (DOACs) do not require monitoring. Measurement of DOAC effect would be useful in the event of bleeding, trauma, and thromboembolism while on anticoagulation. We evaluated the effectiveness of the investigational DOAC assays on the TEG®6s Hemostasis Analyzer to assess the anticoagulant effect of DOACs in patients treated for atrial fibrillation or DVT. Methods: Patients on treatment for a minimum of 7 days with standard doses of dabigatran, rivaroxaban and apixaban were included. DOAC plasma concentrations and TEG®6s R-time were measured and correlated. The sensitivity, specificity and negative predictive value (NPV) of R-time to detect DOAC concentrations of ≥ 30, ≥ 50 and ≥ 100 ng/mL were calculated. Results: 189 Subjects were included, (n=50) on apixaban, (n= 62) on rivaroxaban, (n=53) on dabigatran and (n=24) on no DOAC were studied. Using the direct thrombin inhibitor (DTI) channel, R-time demonstrated strong linear correlation with dabigatran levels (r = 0.93, p < 0.0001). Using the anti-factor Xa (AFXa) channel, R-time demonstrated strong non-linear correlation with rivaroxaban and apixaban levels (rs = 0.92 and 0.84 respectively, p < 0.0001 for both). R-time revealed strong sensitivity and NPV in detecting low DOAC levels for the predefined concentrations. Conclusion: R-time measured by TEG®6s DOAC Specific cartridge has a strong correlation with concentrations of the most commonly used DOACs, with high sensitivity and NPV for detecting lower drug levels that are considered clinically relevant for patients in need of antidote, or prior to urgent surgery. Further studies to determine the relation of R-time to clinical outcomes are warranted.Ramin ArtangJoao DiasMark WalshKevin P BlidenJørn Dalsgaard NielsenMaren AndersonBrain ThurstonUdaya S. TantryJan HartmannPaul A GurbelGeorg Thieme Verlag KGarticleDiseases of the circulatory (Cardiovascular) systemRC666-701ENTH Open (2021) |
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Diseases of the circulatory (Cardiovascular) system RC666-701 |
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Diseases of the circulatory (Cardiovascular) system RC666-701 Ramin Artang Joao Dias Mark Walsh Kevin P Bliden Jørn Dalsgaard Nielsen Maren Anderson Brain Thurston Udaya S. Tantry Jan Hartmann Paul A Gurbel Measurement of Anticoagulation in Patients on Dabigatran, Rivaroxaban and Apixaban Therapy by Novel Automated Thrombelastography |
| description |
Background: Direct-acting oral anticoagulants (DOACs) do not require monitoring. Measurement of DOAC effect would be useful in the event of bleeding, trauma, and thromboembolism while on anticoagulation. We evaluated the effectiveness of the investigational DOAC assays on the TEG®6s Hemostasis Analyzer to assess the anticoagulant effect of DOACs in patients treated for atrial fibrillation or DVT.
Methods: Patients on treatment for a minimum of 7 days with standard doses of dabigatran, rivaroxaban and apixaban were included. DOAC plasma concentrations and TEG®6s R-time were measured and correlated. The sensitivity, specificity and negative predictive value (NPV) of R-time to detect DOAC concentrations of ≥ 30, ≥ 50 and ≥ 100 ng/mL were calculated.
Results: 189 Subjects were included, (n=50) on apixaban, (n= 62) on rivaroxaban, (n=53) on dabigatran and (n=24) on no DOAC were studied. Using the direct thrombin inhibitor (DTI) channel, R-time demonstrated strong linear correlation with dabigatran levels (r = 0.93, p < 0.0001). Using the anti-factor Xa (AFXa) channel, R-time demonstrated strong non-linear correlation with rivaroxaban and apixaban levels (rs = 0.92 and 0.84 respectively, p < 0.0001 for both). R-time revealed strong sensitivity and NPV in detecting low DOAC levels for the predefined concentrations.
Conclusion: R-time measured by TEG®6s DOAC Specific cartridge has a strong correlation with concentrations of the most commonly used DOACs, with high sensitivity and NPV for detecting lower drug levels that are considered clinically relevant for patients in need of antidote, or prior to urgent surgery. Further studies to determine the relation of R-time to clinical outcomes are warranted. |
| format |
article |
| author |
Ramin Artang Joao Dias Mark Walsh Kevin P Bliden Jørn Dalsgaard Nielsen Maren Anderson Brain Thurston Udaya S. Tantry Jan Hartmann Paul A Gurbel |
| author_facet |
Ramin Artang Joao Dias Mark Walsh Kevin P Bliden Jørn Dalsgaard Nielsen Maren Anderson Brain Thurston Udaya S. Tantry Jan Hartmann Paul A Gurbel |
| author_sort |
Ramin Artang |
| title |
Measurement of Anticoagulation in Patients on Dabigatran, Rivaroxaban and Apixaban Therapy by Novel Automated Thrombelastography |
| title_short |
Measurement of Anticoagulation in Patients on Dabigatran, Rivaroxaban and Apixaban Therapy by Novel Automated Thrombelastography |
| title_full |
Measurement of Anticoagulation in Patients on Dabigatran, Rivaroxaban and Apixaban Therapy by Novel Automated Thrombelastography |
| title_fullStr |
Measurement of Anticoagulation in Patients on Dabigatran, Rivaroxaban and Apixaban Therapy by Novel Automated Thrombelastography |
| title_full_unstemmed |
Measurement of Anticoagulation in Patients on Dabigatran, Rivaroxaban and Apixaban Therapy by Novel Automated Thrombelastography |
| title_sort |
measurement of anticoagulation in patients on dabigatran, rivaroxaban and apixaban therapy by novel automated thrombelastography |
| publisher |
Georg Thieme Verlag KG |
| publishDate |
2021 |
| url |
https://doaj.org/article/a579f2aee73f467a8bd1e62b2bbf4b46 |
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