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Ebner, M.* ; Birschmann, I.* ; Peter, A. ; Spencer, C.* ; Haertig, F.* ; Kuhn, J.* ; Blumenstock, G.* ; Zuern, C.S.* ; Ziemann, U.* ; Poli, S.*

Point-of-care testing for emergency assessment of coagulation in patients treated with direct oral anticoagulants.

Crit. Care 21:32 (2017)
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Background: Point-of-care testing (POCT) of coagulation has been proven to be of great value in accelerating emergency treatment. Specific POCT for direct oral anticoagulants (DOAC) is not available, but the effects of DOAC on established POCT have been described. We aimed to determine the diagnostic accuracy of Hemochron (R) Signature coagulation POCT to qualitatively rule out relevant concentrations of apixaban, rivaroxaban, and dabigatran in real-life patients. Methods: We enrolled 68 patients receiving apixaban, rivaroxaban, or dabigatran and obtained blood samples at six pre-specified time points. Coagulation testing was performed using prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), and activated clotting time (ACT+ and ACT-low range) POCT cards. For comparison, laboratory-based assays of diluted thrombin time (Hemoclot) and anti-Xa activity were conducted. DOAC concentrations were determined by liquid chromatography-tandem mass spectrometry. Results: Four hundred and three samples were collected. POCT results of PT/INR and ACT+ correlated with both rivaroxaban and dabigatran concentrations. Insufficient correlation was found for apixaban. Rivaroxaban concentrations at < 30 and < 100 ng/mL were detected with > 95% specificity at PT/INR POCT <= 1.0 and <= 1.1 and ACT+ POCT <= 120 and <= 130 s. Dabigatran concentrations at < 30 and < 50 ng/mL were detected with > 95% specificity at PT/INR POCT < 1.1 and <= 1.2 and ACT+ POCT <= 100 s. Conclusions: Hemochron (R) Signature POCT can be a fast and reliable alternative for guiding emergency treatment during rivaroxaban and dabigatran therapy. It allows the rapid identification of a relevant fraction of patients that can be treated immediately without the need to await the results of much slower laboratory-based coagulation tests.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Point-of-care Testing ; Poct ; Direct Oral Anticoagulants ; Doac ; Non-vitamin K Antagonist Oral Anticoagulants ; Noac ; Emergency Surgery ; Anticoagulation Reversal ; Thrombolysis ; Stroke; Trough Plasma-levels; Atrial-fibrillation; Practical Guide; Dabigatran; Management; Rivaroxaban; Complications; Association; Performance; Thrombin
ISSN (print) / ISBN 1364-8535
e-ISSN 1466-609X
Journal Critical Care
Quellenangaben Volume: 21, Issue: 1, Pages: , Article Number: 32 Supplement: ,
Publisher BioMed Central
Publishing Place London
Reviewing status Peer reviewed