1. Point-of-care testing for emergency assessment of coagulation in patients treated with direct oral anticoagulants
- Author
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Christine S. Zuern, Charlotte Spencer, Andreas Peter, Ingvild Birschmann, Florian Härtig, Ulf Ziemann, Matthias Ebner, Sven Poli, Joachim Kuhn, and Gunnar Blumenstock
- Subjects
medicine.medical_specialty ,Pyridones ,DOAC ,Point-of-Care Systems ,Thrombin Time ,Activated clotting time ,030204 cardiovascular system & hematology ,Thrombin time ,600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit ,Critical Care and Intensive Care Medicine ,POCT ,Dabigatran ,Direct oral anticoagulants ,03 medical and health sciences ,0302 clinical medicine ,Rivaroxaban ,medicine ,Coagulation testing ,Humans ,Prospective Studies ,NOAC ,Prothrombin time ,medicine.diagnostic_test ,business.industry ,Research ,Anticoagulants ,Anticoagulation reversal ,Thrombolysis ,Surgery ,Point-of-care testing ,Stroke ,Anesthesia ,Point-of-care Testing ,Poct ,Direct Oral Anticoagulants ,Doac ,Non-vitamin K Antagonist Oral Anticoagulants ,Noac ,Emergency Surgery ,Anticoagulation Reversal ,Prothrombin Time ,Emergency surgery ,Pyrazoles ,Apixaban ,Partial Thromboplastin Time ,Non-vitamin K antagonist oral anticoagulants ,Blood Coagulation Tests ,business ,030217 neurology & neurosurgery ,medicine.drug ,Partial thromboplastin time ,Factor Xa Inhibitors - Abstract
Background Point-of-care testing (POCT) of coagulation has been proven to be of great value in accelerating emergency treatment. Specific POCT for direct oral anticoagulants (DOAC) is not available, but the effects of DOAC on established POCT have been described. We aimed to determine the diagnostic accuracy of Hemochron® Signature coagulation POCT to qualitatively rule out relevant concentrations of apixaban, rivaroxaban, and dabigatran in real-life patients. Methods We enrolled 68 patients receiving apixaban, rivaroxaban, or dabigatran and obtained blood samples at six pre-specified time points. Coagulation testing was performed using prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), and activated clotting time (ACT+ and ACT-low range) POCT cards. For comparison, laboratory-based assays of diluted thrombin time (Hemoclot) and anti-Xa activity were conducted. DOAC concentrations were determined by liquid chromatography-tandem mass spectrometry. Results Four hundred and three samples were collected. POCT results of PT/INR and ACT+ correlated with both rivaroxaban and dabigatran concentrations. Insufficient correlation was found for apixaban. Rivaroxaban concentrations at 95% specificity at PT/INR POCT ≤1.0 and ≤1.1 and ACT+ POCT ≤120 and ≤130 s. Dabigatran concentrations at 95% specificity at PT/INR POCT ≤1.1 and ≤1.2 and ACT+ POCT ≤100 s. Conclusions Hemochron® Signature POCT can be a fast and reliable alternative for guiding emergency treatment during rivaroxaban and dabigatran therapy. It allows the rapid identification of a relevant fraction of patients that can be treated immediately without the need to await the results of much slower laboratory-based coagulation tests. Trial registration Unique identifier, NCT02371070. Retrospectively registered on 18 February 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1619-z) contains supplementary material, which is available to authorized users.
- Published
- 2017