Global thromboelastometry in patients receiving direct oral anticoagulants: the RO-DOA study

Vedovati, Maria Cristina; Mosconi, Maria Giulia; Isidori, Federico; Agnelli, Giancarlo; Becattini, Cecilia

doi:10.1007/s11239-019-01956-0

Cited by 17 publications

(26 citation statements)

References 40 publications

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“…Therefore, these combinations should be avoided or DOAC concentrations should be monitored. To monitor the effect of apixaban with rotational thromboelastometry, modified assays with lower tissue factor concentrations are needed [71,72].…”

Section: Covid-19 Heparin Resistance and Anticoagulation Monitoring With Rotational Thromboelastometrymentioning

confidence: 99%

The role of rotational thromboelastometry during the COVID-19 pandemic: a narrative review

Görlinger

Almutawah

Alwabari

et al. 2021

Korean J Anesthesiol

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The coronavirus disease 2019 (COVID-19) pandemic is currently recognized as a global health crisis. This viral infection is frequently associated with hypercoagulability, with a high incidence of thromboembolic complications that can be fatal. In many situations, the standard coagulation tests (SCT) fail to detect this state of hypercoagulability in patients with COVID-19 since clotting times are either not or only mildly affected. The role of viscoelastic tests such as rotational thromboelastometry (ROTEM®) during this pandemic is explored in this review. COVID-19-associated coagulopathy, as measured using the rotational thromboelastometry parameters, can vary from hypercoagulability due to increased fibrin polymerization and decreased fibrinolysis to bleeding from hypocoagulability. The use of a multimodal diagnostic and monitoring approach, including both rotational thromboelastometry and SCT, such as plasma fibrinogen and D-dimer concentrations, is recommended. Rotational thromboelastometry provides comprehensive information about the full coagulation status of each patient and detects individual variations. Since COVID-19-associated coagulopathy is a very dynamic process, the phenotype can change during the course of infection and in response to anticoagulation therapy. Data from published literature provide evidence that the combination of rotational thromboelastometry and SCT analysis is helpful in detecting hemostasis issues, guiding anticoagulant therapy, and improving outcomes in COVID-19 patients. However, more research is needed to develop evidence-based guidelines and protocols.

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Section: Covid-19 Heparin Resistance and Anticoagulation Monitoring With Rotational Thromboelastometrymentioning

confidence: 99%

The role of rotational thromboelastometry during the COVID-19 pandemic: a narrative review

Görlinger

Almutawah

Alwabari

et al. 2021

Korean J Anesthesiol

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“…Using modified assays with lower amounts of tissue factor and ecarin-based assays led to more sensitive detection compared to standard tests [24,27,41]. Further improvements and combination of these tests allow differentiation of rivaroxaban and dabigatran as Vedovati et al and we have demonstrated recently [18,19]. Two recently published studies with the TEG 6 s system successfully evaluated in-vivo samples to detect patients on DOAC treatment and to differentiate controls, patients on DXaIs and patients on dabigatran [42,43].…”

Section: Discussionmentioning

confidence: 87%

“…In this regard, standard thromboelastometric tests are poor in detection of DXaIs at low concentrations or even differentiation between DXAIs on the one hand, and DTI and VKAs on the other hand [17]. To improve DOACdetection we have recently shown that a set of modified thromboelastometric assays can differentiate rivaroxaban and dabigatran [18,19]. However, it is unclear whether a set of standard and modified thromboelastometric tests allows detection of the further available DXaIs (apixaban, edoxaban) and differentiation to VKAs or DIL, respectively.…”

Section: Introductionmentioning

confidence: 99%

Point-of-care detection and differentiation of anticoagulant therapy - development of thromboelastometry-guided decision-making support algorithms

et al. 2021

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Background DOAC detection is challenging in emergency situations. Here, we demonstrated recently, that modified thromboelastometric tests can reliably detect and differentiate dabigatran and rivaroxaban. However, whether all DOACs can be detected and differentiated to other coagulopathies is unclear. Therefore, we now tested the hypothesis that a decision tree-based thromboelastometry algorithm enables detection and differentiation of all direct Xa-inhibitors (DXaIs), the direct thrombin inhibitor (DTI) dabigatran, as well as vitamin K antagonists (VKA) and dilutional coagulopathy (DIL) with high accuracy. Methods Following ethics committee approval (No 17–525-4), and registration by the German clinical trials database we conducted a prospective observational trial including 50 anticoagulated patients (n = 10 of either DOAC/VKA) and 20 healthy volunteers. Blood was drawn independent of last intake of coagulation inhibitor. Healthy volunteers served as controls and their blood was diluted to simulate a 50% dilution in vitro. Standard (extrinsic coagulation assay, fibrinogen assay, etc.) and modified thromboelastometric tests (ecarin assay and extrinsic coagulation assay with low tissue factor) were performed. Statistical analyzes included a decision tree analyzes, with depiction of accuracy, sensitivity and specificity, as well as receiver-operating-characteristics (ROC) curve analysis including optimal cut-off values (Youden-Index). Results First, standard thromboelastometric tests allow a good differentiation between DOACs and VKA, DIL and controls, however they fail to differentiate DXaIs, DTIs and VKAs reliably resulting in an overall accuracy of 78%. Second, adding modified thromboelastometric tests, 9/10 DTI and 28/30 DXaI patients were detected, resulting in an overall accuracy of 94%. Complex decision trees even increased overall accuracy to 98%. ROC curve analyses confirm the decision-tree-based results showing high sensitivity and specificity for detection and differentiation of DTI, DXaIs, VKA, DIL, and controls. Conclusions Decision tree-based machine-learning algorithms using standard and modified thromboelastometric tests allow reliable detection of DTI and DXaIs, and differentiation to VKA, DIL and controls. Trial registration Clinical trial number: German clinical trials database ID: DRKS00015704.

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“…Therefore, the main strategy must be probably based on the use of the specific DOAC tests. Unless a DOAC-specific ROTEM test 60 will be validated, the current use of ROTEM should be probably limited to those cases where a (specific) DOAC in already known to be involved, or where specific testing may not be available, or may be delayed.…”

Section: Rotem In Monitoring Oral Fxai Levels/activity and In Oral Fxai-associated Bleedingmentioning

confidence: 99%

ROTEM Testing for Direct Oral Anticoagulants

Korpallová

Samoš

Bolek

et al. 2021

Semin Thromb Hemost

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Direct oral anticoagulants (DOACs) are increasingly used worldwide for the prevention of stroke in patients with atrial fibrillation and to prevent or treat venous thromboembolism. In situations such as serious bleeding, the need for urgent surgery/intervention or the management of a thromboembolic event, the laboratory measurement of DOACs levels or anticoagulant activity may be required. Rotational thromboelastometry (ROTEM) is a viscoelastic hemostatic assay (VHA) which has been used in emergencies (trauma and obstetrics), and surgical procedures (cardiac surgery and liver transplants), but experience with this assay in DOACs-treated patients is still limited. This article reviews the use of ROTEM in the setting of DOACs therapy, focusing on DOACs-associated bleeding and the use of this VHA for the management of reversal strategies for DOACs-associated anticoagulation.

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Global thromboelastometry in patients receiving direct oral anticoagulants: the RO-DOA study

Cited by 17 publications

References 40 publications

The role of rotational thromboelastometry during the COVID-19 pandemic: a narrative review

The role of rotational thromboelastometry during the COVID-19 pandemic: a narrative review

Point-of-care detection and differentiation of anticoagulant therapy - development of thromboelastometry-guided decision-making support algorithms

ROTEM Testing for Direct Oral Anticoagulants

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