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Verfasst von:Ebner, Matthias [VerfasserIn]   i
 Rupp, André [VerfasserIn]   i
Titel:Limitations of specific coagulation tests for direct oral anticoagulants
Titelzusatz:a critical a nalysis
Verf.angabe:Ebner Matthias, Birschmann Ingvild, Peter Andreas, Härtig Florian, Spencer Charlotte, Kuhn Joachim, Rupp André, Blumenstock Gunnar, Zuern Christine S., Ziemann Ulf, Poli Sven
E-Jahr:2018
Jahr:2 Oct 2018
Umfang:11 S.
Fussnoten:Gesehen am 12.07.2019
Titel Quelle:Enthalten in: American Heart AssociationJournal of the American Heart Association
Ort Quelle:New York, NY : Association, 2012
Jahr Quelle:2018
Band/Heft Quelle:7(2018,19) Artikel-Nummer e 009807, 11 Seiten
ISSN Quelle:2047-9980
Abstract:BackgroundDuring treatment with direct oral anticoagulants (DOAC), coagulation assessment is required before thrombolysis, surgery, and if anticoagulation reversal is evaluated. Limited data support the accuracy of DOAC‐specific coagulation assays around the current safe‐for‐treatment threshold of 30 ng/mL.Methods and ResultsIn 481 samples obtained from 96 patients enrolled at a single center, DOAC concentrations were measured using Hemoclot direct thrombin inhibitor assay, Biophen direct thrombin inhibitor assay or ecarin clotting time for dabigatran, chromogenic anti‐Xa assay (AXA) for factor Xa inhibitors (rivaroxaban, apixaban) and ultraperformance liquid chromatography-tandem mass spectrometry as reference. All dabigatran‐specific assays had high sensitivity to concentrations >30 ng/mL, but specificity was lower for Hemoclot direct thrombin inhibitor assay (78.2%) than for Biophen direct thrombin inhibitor assay (98.9%) and ecarin clotting time (94.6%). AXA provided high sensitivity and specificity for rivaroxaban, but low sensitivity for apixaban (73.8%; concentrations up to 82 ng/mL were misclassified as <30 ng/mL). If no DOAC‐specific calibration for AXA is available, results 2‐fold above the upper limit of normal indicate relevant rivaroxaban concentrations. For apixaban, all elevated results should raise suspicion of relevant anticoagulation.ConclusionsDOAC‐specific tests differ considerably in diagnostic performance for concentrations close to the currently accepted safe‐for‐treatment threshold. Compared with Biophen direct thrombin inhibitor assay and ecarin clotting time, limited specificity of Hemoclot direct thrombin inhibitor assay poses a high risk of unnecessary anticoagulation reversal or treatment delays in patients on dabigatran. While AXA accurately detected rivaroxaban, the impact of low apixaban levels on the assay was weak. Hence, AXA results need to be interpreted with extreme caution when used to assess hemostatic function in patients on apixaban.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifiers: NCT02371044, NCT02371070.
DOI:doi:10.1161/JAHA.118.009807
URL:Bitte beachten Sie: Dies ist ein Bibliographieeintrag. Ein Volltextzugriff für Mitglieder der Universität besteht hier nur, falls für die entsprechende Zeitschrift/den entsprechenden Sammelband ein Abonnement besteht oder es sich um einen OpenAccess-Titel handelt.

Volltext: https://doi.org/10.1161/JAHA.118.009807
 Volltext: https://www.ahajournals.org/doi/10.1161/JAHA.118.009807
 DOI: https://doi.org/10.1161/JAHA.118.009807
Datenträger:Online-Ressource
Sprache:eng
K10plus-PPN:1669060624
Verknüpfungen:→ Zeitschrift

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