ROTEM Testing for Direct Oral Anticoagulants

Abstract

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.

The Composition and Physical Properties of Clots in COVID-19 Pathology

“…Moreover, patients with an increased risk for thrombotic complications, i.e., with hypercoagulability are often receiving thromboprophylaxis that interferes with the coagulation assays and requires monitoring. Importantly ROTEM has shown a good sensitivity for monitoring thromboprophylaxis in patients receiving LMWH and DOACs and also in vitro [53][54][55][56].These findings are suggestive for the promising role of ROTEM as a novel promising monitoring tool; however, further DOACs specific validation will be required for implementing ROTEM in daily clinical practice [57].…”

Tailored Direct Oral Anticoagulation in Patients with Atrial Fibrillation: The Future of Oral Anticoagulation?

“…Although liquid chromatography-mass spectrometry (LC-MS) is still honored as a standard laboratory method for DOAC levels quantification [ 10 , 11 , 12 ], especially in the settings of preclinical/clinical research, there is a general consensus that the method is not very useful for the assessment of DOAC levels in routine clinical practice [ 13 ], mostly due to its limitations, such as bad availability, the need for specially equipped laboratory with specially skilled staff and time demands. Furthermore, standard coagulation test (prothrombin time, activated partial thromboplastin time, thrombin time) do not have sufficient sensitivity for DOAC levels assessment, especially when low DOAC levels are expected [ 10 , 13 ], and this could probably also be applied to standard reagents of novel viscoelastic hemostatic assays [ 14 ]. Therefore, DOAC-specific coagulation assays (ecarin clotting time assay or diluted thrombin time assays for dabigatran, and drug-specific chromogenic anti-Xa assays for apixaban, edoxaban and rivaroxaban) are arguably the most appropriate tests from the currently available laboratory methods for routine DOAC levels assessment ( Table 2 ), as the assays demonstrated good correlation with LC-MS [ 11 , 12 ] and good clinical utility in previous post-marketing studies [ 15 , 16 , 17 ].…”

Rotational thromboelastometry in patients with type 2 diabetes and mild COVID-19 pneumonia: A pilot prospective study

“…For example, clotting time could be prolonged due to inherited coagulation disorder, or acquired coagulation disorder (such as liver failure), or drug-induced (due to anticoagulation), thus knowing the patient history or additional laboratory testing might be needed for appropriate interpretation of ROTEM® results. [ 5 , 7 ]…”

“…For example, clotting time could be prolonged due to inherited coagulation disorder, or acquired coagulation disorder (such as liver failure), or drug-induced (due to anticoagulation), thus knowing the patient history or additional laboratory testing might be needed for appropriate interpretation of ROTEM® results. [5,7] Type 2 diabetes mellitus (T2D) is connected with hypercoagulation and is a known risk factor for venous thromboembolism (VTE). A previous meta-analysis reported a 1.4-fold increased risk of VTE in patients with T2D.…”