Measurement of Non–Vitamin K Antagonist Oral Anticoagulants in Patient Plasma Using Heptest-STAT Coagulation Method

Du, Shanshan; Harenberg, Job; Kramer, Sandra S.; Krämer, Roland; Wehling, Martin; Weiß, Christel

doi:10.1097/ftd.0000000000000157

Cited by 9 publications

(6 citation statements)

References 41 publications

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“…Dabigatran prolongs the dTT in a linear dose relationship and can accurately predict anticoagulation intensity . The dTT demonstrated a high correlation with dabigatran concentrations when used with both in‐house and Hemoclot‐derived dabigtran calibrators (correlation coefficient of 0.9981 and 0.9982, respectively) . When available, the dTT is suitable for quantitative assessment of the magnitude of anticoagulant intensity with dabigatran .…”

Section: Laboratory Coagulation Monitoringmentioning

confidence: 98%

“…15 The dTT demonstrated a high correlation with dabigatran concentrations when used with both in-house and Hemoclot-derived dabigtran calibrators (correlation coefficient of 0.9981 and 0.9982, respectively). 23 When available, the dTT is suitable for quantitative assessment of the magnitude of anticoagulant intensity with dabigatran. 15,20 A normal dTT indicates no clinically relevant anticoagulation from dabigatran.…”

Section: Direct Thrombin Inhibitorsmentioning

confidence: 99%

“…An ex vivo plasma study on dabigatran-treated patients has an acceptable correlation between dabigatran and the modified HepTest STAT (correlation coefficient of 0.72 and 0.80 for two chromogenic dabigatran assays). 23…”

Section: Direct Thrombin Inhibitorsmentioning

confidence: 99%

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Laboratory and Clinical Monitoring of Direct Acting Oral Anticoagulants: What Clinicians Need to Know

et al. 2017

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The direct acting oral anticoagulants (DOACs), including dabigatran, rivaroxaban, apixaban, and edoxaban, have favorable pharmacokinetic and pharmacodynamic properties and equal or superior efficacy and an improved safety profile compared with warfarin. Noted shortcomings with DOACs are shorter half-lives requiring stricter adherence, lack of standardized laboratory monitoring, lack of anticoagulation reversal agents, and loss of routine coagulation monitoring leading to fewer patient-clinician interactions. This review addresses many of these limitations including monitoring of DOACs for efficacy and toxicity, an assessment of selected qualitative and quantitative tests, and development of monitoring strategies for special populations. Coagulation monitoring is generally recommended only in overdose situations, but once standardized assays are readily available, they could be helpful to ensure efficacy, assess bleeding, and aid in drug selection in a number of other patient scenarios. Coagulation tests that may provide qualitative assessment include activated partial thromboplastin time, prothrombin time, and thrombin time. Methods with potential utility for quantitative assessment of DOACs include plasma drug concentrations, ecarin clotting time, dilute thrombin time, and antifactor Xa concentrations. Noncoagulation laboratory monitoring should include serum creatinine, liver function tests, and complete blood counts. Clinical monitoring of the DOAC-treated patient should include routine assessment of adherence, bleeding risks, and drug interactions. Frequency of monitoring should be 1-3 months after initiation and then at least every 6 months, with more frequent follow-up (i.e., 3 months) based on patient specific characteristics such as age, renal impairment, hepatic impairment, and concomitant drug therapy. The authors provide a practical tool to assist in DOAC monitoring and recommend that pharmacists collaborate with physicians in selecting appropriate patients and tailoring patient-specific monitoring plans.

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Section: Laboratory Coagulation Monitoringmentioning

confidence: 98%

Section: Direct Thrombin Inhibitorsmentioning

confidence: 99%

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Laboratory and Clinical Monitoring of Direct Acting Oral Anticoagulants: What Clinicians Need to Know

et al. 2017

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“…Currently, many tests are used to measure rivaroxaban's effects, but they are limited by a lack of standardization. [13][14][15] Reference values for rivaroxaban plasma assays show wide ranges for trough and peak levels in different studies. 16 Whether keeping the levels within these wide ranges reflects a true rivaroxaban effect or simply reflect "on-therapy" levels in a patient with strong thrombophilia is unclear.…”

Section: Bloodadvancesorg Frommentioning

confidence: 99%

Rivaroxaban dose adjustment using thrombin generation in severe congenital protein C deficiency and warfarin-induced skin necrosis

Menon¹,

Sarode

Zia³

2018

Blood Advances

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“…86 It is, however, recommended that dilute thrombin-based assays, ECT-based assays, or chromogenic anti-IIa assays should be used for determination of dabigatran, whereas chromogenic anti-Xa assay should be used for determination of direct Xa inhibitors such as rivaroxaban. A variety of specific chromogenic anti-IIa and anti-Xa assays are available for measurement of DOACs, 83,[87][88][89][90][91][92] and several of these assays are available as POCT. It is of particular note that all assays should be calibrated with drug-specific calibrators.…”

Section: Testing For Direct Oral Anticoagulantsmentioning

confidence: 99%

Assessing Safety of Thrombolytic Therapy

Kluft

Sidelmann

Gram

2016

Semin Thromb Hemost

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Thrombolytic therapy involves thrombolytic agents administered to patients suffering from venous or arterial thrombosis. The therapy induces systemic effects interrelated with the thrombolytic agent used. Bleeding is a prominent complication of thrombolytic therapy. Exhaustion of coagulation factors, generation of excessive amounts of fibrin degradation products (FDPs), therapy-induced activation of coagulation, therapy-induced anticoagulation, and formation of new fibrin all illustrate the complexity of effects of the treatment and challenges the hemostatic balance in the patients. The therapy-induced effects can be modulated by parallel administration of anticoagulants. Risk assessment is mandatory prior to thrombolytic therapy. Anticoagulated and unconscious patients represent particular safety concerns, and should be fully evaluated. Several guidelines describe the choice of tests and their safety limits in relation to pretreatment evaluation of anticoagulated patients. Fibrinogen depletion and FDPs during treatment may be promising markers for the evaluation of bleeding risk posttreatment. Future risk assessment measures should focus on the dynamics of the hemostatic balance. Here, thromboelastography may be considered a tool addressing clot formation, fibrin structure, and fibrinolytic resistance in parallel. Suitable laboratory analysis performed shortly after treatment may help to recognize severe treatment-induced systemic effects that can be counteracted by rational treatment, thereby reducing bleeding risk.

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Measurement of Non–Vitamin K Antagonist Oral Anticoagulants in Patient Plasma Using Heptest-STAT Coagulation Method

Abstract: The objective of the study was achieved by demonstrating a high correlation of the Heptest-STAT coagulation assay with chromogenic assays for factor Xa inhibiting NOACs and acceptably good correlation with thrombin inhibiting NOACs in plasma samples of patients on treatment.

Cited by 9 publications

References 41 publications

Laboratory and Clinical Monitoring of Direct Acting Oral Anticoagulants: What Clinicians Need to Know

Laboratory and Clinical Monitoring of Direct Acting Oral Anticoagulants: What Clinicians Need to Know

Rivaroxaban dose adjustment using thrombin generation in severe congenital protein C deficiency and warfarin-induced skin necrosis

Assessing Safety of Thrombolytic Therapy

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