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Minerva Anestesiologica 2021 Feb 16

DOI: 10.23736/S0375-9393.21.14788-1


language: English

Direct oral anticoagulants in point-of-care monitoring: an ex-vivo study (NOAPOC)

Matthias KLAGES 1, 2 , Florian J. RAIMANN 1, Anna-Lena PHILIPP 3, Edelgard LINDHOFF-LAST 4, Kai ZACHAROWSKI 1, Haitham MUTLAK 1, 5

1 Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany; 2 Department of Anesthesiolgy, Intensive Care Medicine und Pain Therapy, Protestant Hospital Düsseldorf, Düsseldorf, Germany; 3 Asklepios Psychiatric Clinic, Langen, Germany; 4 CCB - Cardiovascular Center Bethanien, Frankfurt/Main, Germany; 5 Department of Anesthesiolgy, Intensive Care Medicine und Pain Therapy, Sana Clinic Offenbach, Offenbach/Main, Germany


BACKGROUND: Anticoagulatory activity of direct oral anticoagulants (DOACs) is not routinely measurable by point-of-care monitoring. Thus, the aim of this study was to evaluate the influence of dabigatran/rivaroxaban on point-of-care testing.
METHODS: Samples from 34 participants under DOAC therapy were drawn at two time points. Before ingestion and two-to-three hours afterwards. Thrombelastometric (ROTEM) and aggregometric (Multiplate) measurements were performed. Dabigatran and rivaroxaban plasma levels were determined.
RESULTS: Dabigatran and rivaroxaban plasma levels showed significant correlations with clotting time (CT) in EXTEM (r = 0.765, p < .0001; r = 0.689, p < .0001) and INTEM (r = 0.792, p < .0001; r = 0.595, p < .001). A positive correlation was identified between dabigatran ingestion and maximum-clot-firmness (MCF) (r = 0.354, p < .05) in the EXTEM test, pronounced in the absence of concomitant antiplatelet therapy (r = 0.709, p <.05). EXTEM-MCF positively correlated with the TRAP test in aggregometry (0.662, p < .05), an effect not observed in patients treated with antiplatelet therapy.
CONCLUSIONS: Prolongation of CT-EXTEM and CT-INTEM indicates delayed initiation of clot formation. The CT-EXTEM seems to facilitate qualitative monitoring of dabigatran. In contrast, qualitative monitoring of rivaroxaban by CT-EXTEM may be limited as rivaroxaban may affect the measurement at therapeutic plasma levels. It seems that clot formation is faster/firmer in the presence of increased dabigatran plasma levels. This can be attributed to a non-dose-dependent effect via increased fibrin polymerization and second to a dosedependent effect via increased platelet sensitivity to thrombin.

KEY WORDS: Point-of-care testing; DOAC; Direct oral anticoagulants; ROTEM®; Multiplate®

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