Interference of the new oral anticoagulant dabigatran with frequently used coagulation tests

Halbmayer, Walter‐Michael; Weigel, Guenter; Quehenberger, Peter; Tomasits, Josef; Haushofer, Alexander; Aspoeck, Gerold; Loacker, Lorin; Schnapka-Koepf, Mirjam; Goebel, Georg; Griesmacher, Andrea

doi:10.1515/cclm-2011-0888

Cited by 57 publications

(61 citation statements)

References 12 publications

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“…At clinically relevant plasma concentrations, dabigatran is capable of prolonging the aPTT, TT, and ecarin clotting time (ECT). However, it has variable effects on the prothrombin time and international normalized ratio, rendering these tests poor surrogates of anticoagulation status in patients receiving dabigatran (26,31,32). TT is the most sensitive test for the detection of dabigatran activity (33); it is so sensitive that it often exceeds the upper limit of detection, which we observed in all five cases.…”

Section: Discussionmentioning

confidence: 75%

Extracorporeal Therapy for Dabigatran Removal in the Treatment of Acute Bleeding

Singh

Maw

Henry³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Dabigatran is an oral direct thrombin inhibitor that is Food and Drug Administrationapproved for prevention of stroke in patients with atrial fibrillation. No antidote is available for reversal of dabigatran's anticoagulant effect. Despite limited clinical data, hemodialysis has been suggested as a strategy to remove dabigatran during acute bleeding. This work presents five cases, in which extracorporeal therapy was performed for dabigatran removal in acutely bleeding patients.Design, setting, participants, & measurements The series is comprised of five consecutive cases of patients receiving dabigatran 150 mg per os two times daily who were admitted with life-threatening bleeding between March of 2012 and January of 2013. Dabigatran plasma concentrations ranged from 149 to 1200 ng/ml. Treatment included administration of blood products to all patients and then, high-flux intermittent hemodialysis alone or followed by continuous renal replacement therapy.Results Dabigatran concentrations decreased by 52%-77% during intermittent hemodialysis but rebounded up to 87% within 2 hours after completion of dialysis. Initiation of continuous renal replacement therapy after intermittent hemodialysis attenuated the rebound effect in one patient and contributed to a reduction in dabigatran concentrations of 81% over 30 hours.Conclusions Extracorporeal therapy lowered dabigatran concentrations, suggesting that it removed the drug and may effectively accelerate total clearance, especially in patients with impaired kidney function. The use of prolonged intermittent hemodialysis or intermittent hemodialysis followed by continuous renal replacement therapy is recommended for the management of life-threatening bleeding in patients receiving dabigatran. The advantage of extracorporeal therapy should be weighed against the risk of bleeding with catheter insertion.

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Section: Discussionmentioning

confidence: 75%

Extracorporeal Therapy for Dabigatran Removal in the Treatment of Acute Bleeding

Singh

Maw

Henry³

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…c FXIII when measured by chromogenic substrates may be underestimated in patients on dabigatran, 25 simply because FXIII is activated by thrombin. c Although few data are available, it is possible that measurements of proteins C and S, performed with clotting techniques, 26 individual coagulation factors, 26,27 and the search for lupus anticoagulants, 28 may also be affected by DOAC.…”

Section: 24mentioning

confidence: 99%

The laboratory and the direct oral anticoagulants

Tripodi

2013

Blood

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Although direct oral anticoagulants do not need laboratory testing for dose adjustment, there are instances when laboratory measurement of the drug anticoagulant effect may be useful. They include before initiation of treatment, before surgical or invasive procedures, on the occasion of hemorrhagic or thrombotic events, and whenever immediate reversal of anticoagulation is needed. Choice of tests should be primarily based on their prompt availability. Accordingly, the dilute-thrombin or the ecarin clotting times are best suited for dabigatran and the prothrombin time or the anti-FXa for rivaroxaban.

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“…That is not surprising, because the Clauss method is based on the conversion of fibrinogen to fibrin by exogenous thrombin. Hence, the inhibition of exogenous thrombin by dabigatran leads to an underestimate of the fibrinogen concentration (28,30 ). The extent of underestimation depends on the method used for testing (28 ), suggesting that the concentration (30 ) and/or the type of thrombin used for testing may play an important role (Table 4).…”

Section: Fibrinogenmentioning

confidence: 99%

The Laboratory and the New Oral Anticoagulants

Tripodi

2013

Clinical Chemistry

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BACKGROUND:The new oral anticoagulants (NOAs) dabigatran, rivaroxaban, and apixaban have proved effective and safe when used in clinical trials, without a need to adjust the dose in response to laboratory testing. This demonstrated efficacy does not necessarily mean that the laboratory, considered the mainstay for the management of the old anticoagulants, will no longer play a role in treatment with NOAs.CONTENT: Laboratories are involved in the management of anticoagulants in 2 ways. The first, monitoring, implies laboratory testing to assess the drug's effect and to adjust the dosage to maintain anticoagulation within the therapeutic interval. This consideration applies to the old drugs. The second way, measurement, implies laboratory evaluations of drug effect to determine whether patients are under-or overanticoagulated, information that can be useful for decision-making in special circumstances. The latter applies to NOAs.

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Interference of the new oral anticoagulant dabigatran with frequently used coagulation tests

Cited by 57 publications

References 12 publications

Extracorporeal Therapy for Dabigatran Removal in the Treatment of Acute Bleeding

Extracorporeal Therapy for Dabigatran Removal in the Treatment of Acute Bleeding

The laboratory and the direct oral anticoagulants

The Laboratory and the New Oral Anticoagulants

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