Contributions
Abstract: PB1828
Type: Publication Only
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
Direct oral anticoagulants (DOAC) do not require routine laboratory monitoring, but it is useful to know the impact on coagulation assays in order to interpret the results specially in emergency situations as bleeding or urgent perioperative management.
Aims
The objective of our study is to determnine de DOAC concentration with specific test in control patients under different DOAC treatment and compare the results with routine coagulation assays in different moments, plasma concentration at peak (3 hours after drug intake) and through (just before intake).
Methods
Samples from volunteers patients with non-valvular atrial fibrillation (NVAF) under DOAC treatmente were collected at peak and through plasma concentrations. For all samples prothrombine time (PT) with Tromborel and activated partial thromboplastin time (APTT) with Actin-FS were measured. For anti-Xa DOAC also anti-Xa activity (heparin calibrated) with Innovance Heparine and plasma concentration with STA-Liquid anti-Xa (Stago) was quantified anf for Dabigatran thrombin time (TT) with Thromboclotin and the specific test STA-ECAII (Stago) were used.
Results
30 patients were included (59% males, median age 71 [IQR 41-88] years. 3 Dabigatran 150 mg/12 hours, 2 Dabigatran 110 mg/12 hours, 8 Rivaroxaban 20 mg/24 hours, 2 Rivaroxaban 15 mg/hours, 14 Apixaban 5 mg/12 hours and 1 Apixaban 2,5 mg/12 hours. The results for different test at peak and through are seen in Table 1. Under Dabigatran TT was uncoagulable for all samples, and all PT and APTT results were pathological. The most statistical correlation test with DOAC level (Apixaban and Rivaroxaban) was anti-Xa (heparin calibrated) specially at throug moment with a P<0.0001
Conclusion
The results of DOAC concentration at peak and through are similar to literature except for Dabigatran that in our study are higher perhaps because there are few samples.
Similar to other studies Dabigatran is the DOAC that most modifies coagulation assays specially APTT also at through moments and Apixaban is the DOAC that nearly no prolongs PT neither APTT on-therapy concentrations.
For these reasons PT and APTT are not recommended to know coagulation state under DOAC treatment. The quatification of DOAC levels in plasma is more informative and useful tan other coagulation parameter so in case to measure low plasma concentrations in special circumstances specific test calibrated are required but if these are not available for direct FXa inhibitors a heparin-calibrated chromogenic assay can be indicative of clinically relevant levels of a ditrect FXa inhibitor.
Keyword(s): Oral anticoagulant
Abstract: PB1828
Type: Publication Only
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
Direct oral anticoagulants (DOAC) do not require routine laboratory monitoring, but it is useful to know the impact on coagulation assays in order to interpret the results specially in emergency situations as bleeding or urgent perioperative management.
Aims
The objective of our study is to determnine de DOAC concentration with specific test in control patients under different DOAC treatment and compare the results with routine coagulation assays in different moments, plasma concentration at peak (3 hours after drug intake) and through (just before intake).
Methods
Samples from volunteers patients with non-valvular atrial fibrillation (NVAF) under DOAC treatmente were collected at peak and through plasma concentrations. For all samples prothrombine time (PT) with Tromborel and activated partial thromboplastin time (APTT) with Actin-FS were measured. For anti-Xa DOAC also anti-Xa activity (heparin calibrated) with Innovance Heparine and plasma concentration with STA-Liquid anti-Xa (Stago) was quantified anf for Dabigatran thrombin time (TT) with Thromboclotin and the specific test STA-ECAII (Stago) were used.
Results
30 patients were included (59% males, median age 71 [IQR 41-88] years. 3 Dabigatran 150 mg/12 hours, 2 Dabigatran 110 mg/12 hours, 8 Rivaroxaban 20 mg/24 hours, 2 Rivaroxaban 15 mg/hours, 14 Apixaban 5 mg/12 hours and 1 Apixaban 2,5 mg/12 hours. The results for different test at peak and through are seen in Table 1. Under Dabigatran TT was uncoagulable for all samples, and all PT and APTT results were pathological. The most statistical correlation test with DOAC level (Apixaban and Rivaroxaban) was anti-Xa (heparin calibrated) specially at throug moment with a P<0.0001
Conclusion
The results of DOAC concentration at peak and through are similar to literature except for Dabigatran that in our study are higher perhaps because there are few samples.
Similar to other studies Dabigatran is the DOAC that most modifies coagulation assays specially APTT also at through moments and Apixaban is the DOAC that nearly no prolongs PT neither APTT on-therapy concentrations.
For these reasons PT and APTT are not recommended to know coagulation state under DOAC treatment. The quatification of DOAC levels in plasma is more informative and useful tan other coagulation parameter so in case to measure low plasma concentrations in special circumstances specific test calibrated are required but if these are not available for direct FXa inhibitors a heparin-calibrated chromogenic assay can be indicative of clinically relevant levels of a ditrect FXa inhibitor.
Keyword(s): Oral anticoagulant