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Härtig, F.* ; Birschmann, I.* ; Peter, A. ; Ebner, M.* ; Spencer, C.* ; Gramlich, M.* ; Richter, H.* ; Kuhn, J.* ; Lehmann, R. ; Blumenstock, G.* ; Zuern, C.S.* ; Ziemann, U.* ; Poli, S.*

Specific point-of-care testing of coagulation in patients treated with dabigatran.

Thromb. Haemost. 121, 782-791 (2021)
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BACKGROUND AND PURPOSE:  Accurate and rapid assessment of coagulation status is necessary to guide thrombolysis or reversal of anticoagulation in stroke patients, but commercially available point-of-care (POC) assays are not suited for coagulation testing in patients treated with direct oral anticoagulants (DOACs). We aimed to evaluate the direct thrombin monitoring (DTM) test card by Helena Laboratories (Texas, United States) for anti-IIa-specific POC coagulation testing, hypothesizing that its POC-ecarin clotting time (POC-ECT) accurately reflects dabigatran plasma concentrations. METHODS:  A prospective single-center diagnostic study (ClinicalTrials.gov-identifier: NCT02825394) was conducted enrolling patients receiving a first dose of dabigatran and patients already on dabigatran treatment. Blood samples were collected before drug intake and 0.5, 1, 2, 8, and 12 hours after intake. POC-ECT was performed using whole blood (WB), citrated blood (CB), and citrated plasma (CP). Dabigatran plasma concentrations were determined by mass spectrometry. RESULTS:  In total, 240 blood samples from 40 patients contained 0 to 275 ng/mL of dabigatran. POC-ECT with WB/CB/CP ranged from 20 to 186/184/316 seconds. Pearson's correlation coefficient showed a strong correlation between dabigatran concentrations and POC-ECT with WB/CB/CP (R2  = 0.78/0.90/0.92). Dabigatran concentrations >30 and >50 ng/mL (thresholds for thrombolysis, surgery, and reversal therapy according to clinical guidelines) were detected by POC-ECT with WB/CB/CP (>36/35/45 and >43/45/59 seconds) with 95/97/97 and 96/98/97% sensitivity, and 81/87/94 and 74/60/91% specificity. CONCLUSION:  This first study evaluating DOAC-specific POC coagulation testing revealed an excellent correlation of POC-ECT with actual dabigatran concentrations. Detecting clinically relevant dabigatran levels with high sensitivity/specificity, the DTM assay represents a suitable diagnostic tool in acute stroke, hemorrhage, and urgent surgery.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Anticoagulation ; Dabigatran ; Ecarin Clotting Time ; Point-of-care Testing ; Thrombolysis; Direct Oral Anticoagulants; Thrombin
Language english
Publication Year 2021
HGF-reported in Year 2021
ISSN (print) / ISBN 0340-6245
Journal Thrombosis and Haemostasis
Quellenangaben Volume: 121, Issue: 6, Pages: 782-791 Article Number: , Supplement: ,
Publisher Schattauer
Publishing Place Rudigerstr 14, D-70469 Stuttgart, Germany
Reviewing status Peer reviewed
Institute(s) Institute of Diabetes Research and Metabolic Diseases (IDM)
POF-Topic(s) 90000 - German Center for Diabetes Research
Research field(s) Helmholtz Diabetes Center
PSP Element(s) G-502400-001
Grants Helena Laboratories (Beaumont, Texas, United States)
DOI 10.1055/s-0040-1721775
WOS ID WOS:000608146700006
Scopus ID 85099582737
PubMed ID 33469905
Erfassungsdatum 2021-03-30
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