PMID- 26924677
OWN - NLM
STAT- MEDLINE
DCOM- 20180102
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7836 (Linking)
VI  - 14
IP  - 5
DP  - 2016 May
TI  - A single test to assay warfarin, dabigatran, rivaroxaban, apixaban, 
      unfractionated heparin, and enoxaparin in plasma.
PG  - 1043-53
LID - 10.1111/jth.13300 [doi]
AB  - Essentials Simple and fast assaying of different anticoagulants (ACs) is useful 
      in emergent situations. We used highly diluted prothrombin time (dPT) or highly 
      diluted Fiix-PT (dFiix-PT) to assay ACs. Both tests could quantify target 
      specific anticoagulants and warfarin anticoagulation. Improved results were 
      consistently observed with the dFiix-PT compared with the dPT. SUMMARY: 
      Background Assaying anticoagulants is useful in emergency situations or before 
      surgery. Different specific assays are currently needed depending on the 
      anticoagulant. Objectives We hypothesized that levels of warfarin, dabigatran, 
      rivaroxaban, apixaban, and heparins could be measured with use of the diluted 
      prothrombin time (dPT) and diluted Fiix-PT (dFiix-PT), using highly diluted 
      thromboplastin (TP). The latter test is affected only by reduced levels of active 
      factors II and X but corrects test plasma for other deficiencies Methods 
      Increasing TP dilutions were used to identify suitable dilutions to measure 
      dabigatran, rivaroxaban, apixaban, unfractionated heparin (UFH), and enoxaparin. 
      Calibrators containing known amounts of direct oral anticoagulants (DOACs) were 
      used to make standard curves. Citrated plasma samples were obtained from patients 
      taking warfarin or DOACs with known drug concentrations as determined by specific 
      assays. Results The dFiix-PT at a TP dilution of 1:1156 could be used to measure 
      all of the drugs tested at therapeutic concentrations except for fondaparinux. 
      The dPT achieved the same but required two TP dilutions (1:750 and 1:300). The 
      warfarin effect could be assessed by using dFiix-PT at 1:1156 with a PT ratio 
      identical to the international normalized ratio. Six different TPs yielded 
      similar results, but two were less sensitive. Dabigatran, rivaroxaban, and 
      apixaban could be accurately measured in patient samples using both dilute PT 
      assays, but a better correlation was consistently observed between the dFiix-PT 
      and specific assays than with the dPT. Conclusion The dFiix-PT using a single 
      dilution of TP may be suitable to assess the anticoagulant effects of warfarin, 
      dabigatran, rivaroxaban, apixaban, heparin, and enoxaparin.
CI  - (c) 2016 International Society on Thrombosis and Haemostasis.
FAU - Letertre, L R
AU  - Letertre LR
AD  - Landspitali The National University Hospital of Iceland, Reykjavik, Iceland.
FAU - Gudmundsdottir, B R
AU  - Gudmundsdottir BR
AD  - Landspitali The National University Hospital of Iceland, Reykjavik, Iceland.
FAU - Francis, C W
AU  - Francis CW
AD  - University of Rochester Medical Center, Rochester, NY, USA.
FAU - Gosselin, R C
AU  - Gosselin RC
AD  - University of California, Davis Medical Center, Sacramento, CA, USA.
FAU - Skeppholm, M
AU  - Skeppholm M
AD  - Danderyd Hospital and Department of Clinical Sciences & Department of Medicine, 
      Solna, Karolinska Institute, Stockholm, Sweden.
FAU - Malmstrom, R E
AU  - Malmstrom RE
AD  - Clinical Pharmacology, Karolinska University Hospital & Department of Medicine, 
      Solna, Karolinska Institutet, Stockholm, Sweden.
FAU - Moll, S
AU  - Moll S
AD  - University of North Carolina School of Medicine, Chapel Hill, NC, USA.
FAU - Hawes, E
AU  - Hawes E
AD  - University of North Carolina School of Medicine, Chapel Hill, NC, USA.
AD  - University of North Carolina Department of Pharmacy, Chapel Hill, NC, USA.
FAU - Francart, S
AU  - Francart S
AD  - University of North Carolina Department of Pharmacy, Chapel Hill, NC, USA.
FAU - Onundarson, P T
AU  - Onundarson PT
AD  - Landspitali The National University Hospital of Iceland, Reykjavik, Iceland.
AD  - Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, 
      Iceland.
LA  - eng
PT  - Journal Article
DEP - 20160330
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Polysaccharides)
RN  - 0 (Pyrazoles)
RN  - 0 (Pyridones)
RN  - 3Z9Y7UWC1J (apixaban)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9001-26-7 (Prothrombin)
RN  - 9001-29-0 (Factor X)
RN  - 9005-49-6 (Heparin)
RN  - 9035-58-9 (Thromboplastin)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
RN  - I0VM4M70GC (Dabigatran)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Anticoagulants/chemistry
MH  - Blood Coagulation Tests/*methods
MH  - Blood Donors
MH  - Calibration
MH  - Dabigatran/*blood
MH  - Enoxaparin/*blood
MH  - Factor X/chemistry
MH  - Female
MH  - Fondaparinux
MH  - Heparin/*blood
MH  - Humans
MH  - International Normalized Ratio
MH  - Male
MH  - Polysaccharides/blood
MH  - Prothrombin/chemistry
MH  - Prothrombin Time
MH  - Pyrazoles/*blood
MH  - Pyridones/*blood
MH  - Reproducibility of Results
MH  - Rivaroxaban/*blood
MH  - Thromboplastin/chemistry
MH  - Warfarin/*blood
OTO - NOTNLM
OT  - apixaban
OT  - assay
OT  - dabigatran
OT  - heparin
OT  - rivaroxaban
EDAT- 2016/03/01 06:00
MHDA- 2018/01/03 06:00
CRDT- 2016/03/01 06:00
PHST- 2015/10/09 00:00 [received]
PHST- 2016/02/04 00:00 [accepted]
PHST- 2016/03/01 06:00 [entrez]
PHST- 2016/03/01 06:00 [pubmed]
PHST- 2018/01/03 06:00 [medline]
AID - S1538-7836(22)03512-7 [pii]
AID - 10.1111/jth.13300 [doi]
PST - ppublish
SO  - J Thromb Haemost. 2016 May;14(5):1043-53. doi: 10.1111/jth.13300. Epub 2016 Mar 
      30.