Home > Riviste > Minerva Anestesiologica > Fascicoli precedenti > Articles online first > Minerva Anestesiologica 2021 Feb 16

ULTIMO FASCICOLO
 

JOURNAL TOOLS

eTOC
Per abbonarsi
Sottometti un articolo
Segnala alla tua biblioteca
 

ARTICLE TOOLS

Publication history
Estratti
Permessi
Per citare questo articolo
Share

 

 

Minerva Anestesiologica 2021 Feb 16

DOI: 10.23736/S0375-9393.21.14788-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


PDF


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®

inizio pagina