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. 2021 Mar 16;19(1):18.
doi: 10.1186/s12959-021-00267-w.

Viscoelastometry for detecting oral anticoagulants

Philipp Groene  1 , Daniela Wagner  2 , Tobias Kammerer  2   3 , Lars Kellert  4 , Andreas Giebl  5 , Steffen Massberg  6 , Simon Thomas Schäfer  2
Affiliations

Viscoelastometry for detecting oral anticoagulants

Philipp Groene et al. Thromb J. .

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 (RVV-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 CTRVV-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). CTECA-test correlated strongly with dabigatran plasma concentration (measured by anti-IIa 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 CTRVV-test (r = 0.7998; p < 0.0001), and CTRVV-test 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.

Trial registration: German clinical trials database ID: DRKS00015302 .

Keywords: Anticoagulants; Coagulation tests; Dabigatran; Factor Xa (FXa) inhibitors; Heparin; Viscoelastometry.

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Conflict of interest statement

S.T.S. received lecture fees by CSL Behring, TEM international and Werfen as well as research grants by Octapharma and TEM International. P.G. received lecture fees by CSL Behring, D.W., T.K., L.K., S.M. and A.G. declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Viscoelastometric CT results (scatter dot plots) from the control group and the anticoagulant groups. Data are shown as median and interquartile range. a EX-test, b IN-test, c RVV-test and d ECA-test. * p < 0.05, ** p < 0.01, *** p < 0.001, **** p < 0.0001. CT, clotting time; LMWH, low molecular weight heparin
Fig. 2
Fig. 2
Viscoelastometric TPA-test results (scatter dot plots) from the control group and the anticoagulant groups. Data are shown as median and interquartile range. a CT, b LT, c LOT and d ML. * p < 0.05, ** p < 0.01, *** p < 0.001, **** p < 0.0001. CT, clotting time; LT, lysis time; LOT, lysis onset time; ML, maximum lysis; LMWH, low molecular weight heparin
See this image and copyright information in PMC

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