Viscoelastometry for detecting oral anticoagulants - Kölner UniversitätsPublikationsServer

Groene, Philipp ORCID: 0000-0001-8357-5552, Wagner, Daniela, Kammerer, Tobias ORCID: 0000-0001-8920-7187, Kellert, Lars, Giebl, Andreas, Massberg, Steffen and Schaefer, Simon Thomas (2021). Viscoelastometry for detecting oral anticoagulants. Thromb. J., 19 (1). LONDON: BMC. ISSN 1477-9560

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DOI:10.1186/s12959-021-00267-w

Abstract

Background: Determination of anticoagulant therapy is of pronounced interest in emergency situations. However, routine tests do not provide sufficient insight. This study was performed to investigate the impact of anticoagulants on the results of viscoelastometric assays using the ClotPro device. Methods: This prospective, observational study was conducted in patients receiving dabigatran, factor Xa (FXa)-inhibitors, phenprocoumon, low molecular weight heparin (LMWH) or unfractionated heparin (UFH) (local ethics committee approval number: 17-525-4). Healthy volunteers served as controls. Viscoelastometric assays were performed, including the extrinsic test (EX-test), intrinsic test (IN-test) Russel's viper venom test (RW-test), ecarin test (ECA-test), and the tissue plasminogen activator test (TPA-test). Results: 70 patients and 10 healthy volunteers were recruited. Clotting time in the EX-test (CTEX-test) was significantly prolonged versus controls by dabigatran, FXa inhibitors and phenprocoumon. CTiN-test was prolonged by dabigatran, FXa inhibitors and UFH. Dabigatran, FXa inhibitors and UFH significantly prolonged CTRw-test in comparison with controls (median 200, 207 and 289 vs 63 s, respectively; all p < 0.0005). Only dabigatran elicited a significant increase in CTECA-test compared to controls (median 307 vs 73 s; p < 0.0001). CT EcA _ test correlated strongly with dabigatran plasma concentration (measured by anti-Ila activity; r = 0.9970; p < 0.0001) and provided 100% sensitivity and 100% specificity for detecting dabigatran. Plasma concentrations (anti-XA activity) of FXa inhibitors correlated with CTRW-text (r = 0.7998; p < 0.0001), and CTRW-text provided 83% sensitivity and 64% specificity for detecting FXa inhibitors. Conclusions: In emergency situations, ClotPro viscoelastometric assessment of whole-blood samples may help towards determining the presence and type of anticoagulant class that a patient is taking.

Item Type:

Journal Article

Creators:

Creators	Email	ORCID	ORCID Put Code
Groene, Philipp	UNSPECIFIED	orcid.org/0000-0001-8357-5552	UNSPECIFIED
Wagner, Daniela	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Kammerer, Tobias	UNSPECIFIED	orcid.org/0000-0001-8920-7187	UNSPECIFIED
Kellert, Lars	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Giebl, Andreas	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Massberg, Steffen	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Schaefer, Simon Thomas	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED