Plasma-Diluted Thrombin Time to Measure Dabigatran Concentrations During Dabigatran Etexilate Therapy

Avecilla, Scott T.; Ferrell, Chris; Chandler, Wayne L.; Reyes, Morayma

doi:10.1309/ajcpau7oqm0srpzq

Cited by 78 publications

(58 citation statements)

References 5 publications

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“…Various coagulation assays used in the setting of DOACs are described in Table 1. [25][26][27][28][29][30][31][32][33][34][35] Since the INR and activated partial thromboplastin time (aPTT) are less sensitive measures, they are not reliable estimates for the loss of drug effect, especially not for the oral FXa inhibitors. However, aPTT may be of value for dabigatran, though it does not allow for a precise quantification of the plasma concentration.…”

Section: The Role Of Laboratory Monitoringmentioning

confidence: 99%

Current knowledge on assessing the effects of and managing bleeding and urgent procedures with direct oral anticoagulants

Dager

Hellwig

2016

American Journal of Health-System Pharmacy

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purpose. Current knowledge on managing major bleeding events with available hemostatic agents, including their combined use with potential reversal agents, in patients taking direct oral anticoagulant (DoaCs) is reviewed.Summary. over the past five years, a new generation of oral agents, the DoaCs, has emerged as commonly used anticoagulants for stroke prevention in non-valvular atrial fibrillation, and treatment or secondary prevention of venous thromboembolism. management of a bleeding event in the setting of DoaC therapy should take into account the relative risks of bleeding and thrombosis, which will determine the degree of anticoagulant reversal required. In the setting of a major (critical) bleeding event associated with notable blood loss, management may include transfusions of blood products to sustain the function of organ systems, and the availability of specific reversal agents will provide additional options for bleeding management. beyond withholding the DoaC and providing supportive management that addresses any factors contributing to the bleeding event, clinicians may desire to expedite the removal of any anticoagulation effects. In general, this is accomplished by either removing or neutralizing the anticoagulant or by independently establishing hemostasis. Conclusion.With or without reversal agents, patients may require supportive management such as mechanical pressure, volume support, transfusions of blood products, and, depending on the situation, surgery to repair the bleeding source. specific reversal agents are currently under development or have recently been approved for the urgent management of bleeding events or the facilitation of invasive procedures in patients receiving DoaCs.Am J Health-Syst Pharm. 2016; 73(suppl 2):s14-26

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Section: The Role Of Laboratory Monitoringmentioning

confidence: 99%

Current knowledge on assessing the effects of and managing bleeding and urgent procedures with direct oral anticoagulants

Dager

Hellwig

2016

American Journal of Health-System Pharmacy

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“…Recently, a dilute TT adequately responsive to dabigatran (ie, prolongation up to 2 times the baseline value at 175 ng/mL dabigatran) ( Table 2) has become available and may be used for dabigatran measurement. 11,12 Ecarin is a commercially available snake venom that converts FII into meizothrombin. The dabigatran-induced inhibition of meizothrombin is measured by synthetic substrates or clotting assays.…”

Section: Dabigatranmentioning

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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“…Several coagulation methods to measure DOACs are sufficiently sensitive and provide a linear dose response over a wide concentration range. Two quantitative methods apply to dabigatran: (i) Using a commercial kit [17], or an in-house method [21], to predilute plasma before performing a thrombin time calibrated with dabigatran standards, and (ii) Chromogenic [11] or clot-based [17] ecarin methods. Ecarin, derived from the venom of the Indian saw-scaled viper, Echis carinatus, converts prothrombin to an active intermediate, meizothrombin, which converts fibrinogen to fibrin (clotting method) or hydrolyzes a peptide substrate with an attached chromophobe (chromogenic method).…”

Section: Laboratory Asses Sment Of Direct Oral Anticoagulantsmentioning

confidence: 99%

Novel anticoagulants and laboratory testing

Eby

2013

Int J Lab Hematology

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Summary The introduction of several oral direct anticoagulants within the past 2–3 years has dramatically changed clinical practice and has also impacted on utilization and interpretation of coagulation laboratory testing. This article reviews the effects of the oral thrombin inhibitor, dabigatran, and the oral factor Xa inhibitors, rivaroxaban and apixaban, on screening and diagnostic coagulation tests, and describes methods for measuring the their anticoagulant activity in plasma. Currently, there are evidence gaps regarding the role of laboratory testing for surveillance and management of adverse events associated with these new anticoagulants which do not require routine therapeutic drug monitoring. This is a rapidly changing field, and coagulation laboratory experts have a major role in ensuring patients receive appropriate testing and accurate interpretations of results.

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Plasma-Diluted Thrombin Time to Measure Dabigatran Concentrations During Dabigatran Etexilate Therapy

Cited by 78 publications

References 5 publications

Current knowledge on assessing the effects of and managing bleeding and urgent procedures with direct oral anticoagulants

Current knowledge on assessing the effects of and managing bleeding and urgent procedures with direct oral anticoagulants

The laboratory and the direct oral anticoagulants

Novel anticoagulants and laboratory testing

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