Reduction of the turn‐around time for the measurement of rivaroxaban and apixaban: Assessment of the performance of a rapid centrifugation method

Dincq, Anne-Sophie; Lessire, Sarah; Pirard, G; Siriez, Romain; Guldenpfennig, Maïté; Baudar, Justine; Favresse, Julien; Douxfils, Jonathan; Mullier, François

doi:10.1111/ijlh.12870

Cited by 9 publications

(11 citation statements)

References 12 publications

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“…In spite of this, there was still a wide variation in TAT for both apixaban and rivaroxaban with a maximum TAT of 3 hours 28 minutes. 34 Our median TAT for inpatients was 1 hour 32 minutes with no significant difference between levels processed in or out of hours.…”

Section: Discussionmentioning

confidence: 65%

“…Our median TAT for inpatients was 1 hour 32 minutes with no significant difference between levels processed in or out of hours. Although this is slower than other real‐world studies, it is still clinically useful for most emergency and urgent situations. At our institution, urgent requests are flagged to laboratory staff by a combination of location of origin, for example the emergency department, and by telephone.…”

Section: Discussionmentioning

confidence: 97%

“…In order to be of clinical use in this acute setting, the results of DOAC levels need to be available 24/7 and in a timely manner. The speed with which samples are processed from the point at which they arrive in the laboratory to a result being published is referred to as the turnaround time (TAT) . Few studies have assessed the TAT of DOAC levels but they demonstrate that they can be delivered in a time frame that is clinically relevant .…”

Section: Discussionmentioning

confidence: 99%

“…The improvement in TAT was multifactorial and related to the ready to use reagents, increased laboratory awareness to process DOAC levels and a rapid centrifugation protocol. In spite of this, there was still a wide variation in TAT for both apixaban and rivaroxaban with a maximum TAT of 3 hours 28 minutes …”

Section: Discussionmentioning

confidence: 99%

“…34 Few studies have assessed the TAT of DOAC levels but they demonstrate that they can be delivered in a time frame that is clinically relevant. 34,35 For example, a recent study by Dincq et al achieved median TAT of 61 minutes and 67.6 minutes for apixaban and rivaroxaban respectively. In the period immediately preceding the study, the median TAT for DOAC levels was 4 hours 6 minutes.…”

Section: Discussionmentioning

confidence: 99%

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A level‐headed approach to measuring direct oral anticoagulants: A 2‐year retrospective analysis of DOAC levels from a tertiary UK centre

Denny

Siganporia

et al. 2018

Int J Lab Hematology

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Introduction Direct oral anticoagulants (DOAC) are commonly prescribed and measuring drug levels may be useful in a number of contexts. However, data on DOAC level measurement and their clinical utility in real‐world studies are limited. Methods We carried out a 2‐year retrospective cohort study of DOAC levels measured at our institution. Results One hundred and sixty‐nine levels measured in 113 patients were included in the final analysis. Our patients had a median age of 69.9. AF was the commonest indication for anticoagulation. Median turnaround time for inpatient levels was 92 minutes. Median FXa inhibitor levels within 6 hours of last dose and following one half‐life were similar to those described previously. However, the range of levels was wider than expected. Importantly, some levels remained in an on therapy range even after 3 half‐lives. There was no correlation between dabigatran level and time from last dose. The reason for request varied with setting; 23 outpatient levels were to monitor drug efficacy, whereas 54 and 43 inpatient levels were collected in the context of bleeding and emergency surgery respectively. 60.3% of levels had an impact on clinical decision making. Conclusion Our real‐world study demonstrates that DOAC levels can be performed in a timely manner to influence clinical decision making. In addition, it suggests there is a wide variation in levels such that it can be difficult to predict in the real world. Overall, this supports the wider use of DOAC levels to help guide clinicians in managing patients taking these drugs.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

A level‐headed approach to measuring direct oral anticoagulants: A 2‐year retrospective analysis of DOAC levels from a tertiary UK centre

Denny

Siganporia

et al. 2018

Int J Lab Hematology

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Fully automated thromboelastograph TEG 6s to measure anticoagulant effects of direct oral anticoagulants in healthy male volunteers

Artang

Anderson

Nielsen

2019

Research and Practice in Thrombosis and Haemostasis

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Background The ability to assess the hemostatic effect of the direct oral anticoagulant (DOACs) may be valuable in clinical situations such as bleeding or thrombosis, before urgent surgery, or reversal of anticoagulation. We sought to assess the anticoagulant effect of DOACs with the new‐generation fully automated thrombelastograph TEG 6s using resonance‐frequency viscoelasticity measurements and disposable multichannel microfluidic cartridges. Methods A single dose of oral dabigatran 150 mg, rivaroxaban 20 mg, or apixaban 5 mg was given to 9 healthy males. Phlebotomy was performed at 0, 1, and 3 hours after administration of DOAC. TEG parameters were measured using TEG_6s. Concentrations of DOACs were measured using chromogenic assays. The TEG parameters were correlated to the DOAC concentrations. Results The reaction time (R) demonstrated the strongest response to DOAC intake. There were no correlations between other TEG parameters and DOAC concentrations. Using the direct thrombin inhibitor (DTI) channel, R was significantly correlated with dabigatran levels (r = 0.94, P < 0.0001). Using the anti–factor Xa (AFXa) channel, R was significantly correlated with rivaroxaban and apixaban levels (r = 0.93 and r = 0.83, respectively; P < 0.0001 for both). R >2.5 minutes for dabigatran (DTI channel), >2.5 minutes for apixaban, and >1.8 minutes for rivaroxaban (AFXa channel) were associated with 100% sensitivity and ≥ 90% specificity to detect DOAC levels of ≥ 50 ng/mL. Conclusion We have demonstrated that TEG_6s R has significant correlation with DOAC blood concentrations and has potential for monitoring the DOAC's effect on hemostasis with reasonable sensitivity in the small sample analyzed. This novel technology is easy to use on a small volume of whole blood without requiring a specialized laboratory. Further study is warranted to correlate R with clinical outcomes.

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Management of patients with proximal femur fractures under DOACs

Maegele

2024

Eur J Trauma Emerg Surg

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Purpose In the past, preinjury direct oral anticoagulant (DOAC) intake has led to delays in time to surgery (TTS) in patients with proximal femur fractures and delays in surgery have been associated with impaired outcomes. Although healthcare institutions/federal committees have set rules for treatment within 24 h of injury, comprehensive guidelines for the perioperative management of these patients, in particular when on preinjury DOACs, are still lacking. This contribution aims to summarize the current evidence on the safe time window for surgery in patients with proximal femur fractures on preinjury DOACs and to outline therapeutic options if emergency DOAC reversal becomes necessary. Methods Narrative review based upon selective review of the pertinent literature. Results For the majority of patients with proximal femur fractures and on preinjury DOACs, early surgery appears safe as soon as medical clearance has been obtained. There may be an increase in the need for blood products but with data not yet conclusive. Work-up including assessment of remaining anticoagulant activity and potential reversal should be restricted to patients at risk for bleeding complications, in particular in the presence of renal/hepatic impairment. Methodology for rapid assessment of DOACs including quantitative/qualitative concentration levels is work in progress. In the case of bleeding, rapidly acting reversal agents are available. Conclusion Preinjury DOAC use should not routinely delay surgery in patients with proximal femur fractures.

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Reduction of the turn‐around time for the measurement of rivaroxaban and apixaban: Assessment of the performance of a rapid centrifugation method

Cited by 9 publications

References 12 publications

A level‐headed approach to measuring direct oral anticoagulants: A 2‐year retrospective analysis of DOAC levels from a tertiary UK centre

A level‐headed approach to measuring direct oral anticoagulants: A 2‐year retrospective analysis of DOAC levels from a tertiary UK centre

Fully automated thromboelastograph TEG 6s to measure anticoagulant effects of direct oral anticoagulants in healthy male volunteers

Management of patients with proximal femur fractures under DOACs

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