PMID- 33726769
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210320
IS  - 1477-9560 (Print)
IS  - 1477-9560 (Electronic)
IS  - 1477-9560 (Linking)
VI  - 19
IP  - 1
DP  - 2021 Mar 16
TI  - Viscoelastometry for detecting oral anticoagulants.
PG  - 18
LID - 10.1186/s12959-021-00267-w [doi]
LID - 18
AB  - 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 (CT(EX-test)) was significantly prolonged 
      versus controls by dabigatran, FXa inhibitors and phenprocoumon. CT(IN-test) was 
      prolonged by dabigatran, FXa inhibitors and UFH. Dabigatran, FXa inhibitors and 
      UFH significantly prolonged CT(RVV-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 CT(ECA-test) compared to controls (median 307 vs 73 s; 
      p < 0.0001). CT(ECA-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 CT(RVV-test) 
      (r = 0.7998; p < 0.0001), and CT(RVV-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 .
FAU - Groene, Philipp
AU  - Groene P
AUID- ORCID: 0000-0001-8357-5552
AD  - Department of Anaesthesiology, University Hospital Munich, LMU Munich, 
      Marchioninistrasse 15, 81377, Munich, Germany. philipp.groene@med.uni-muenchen.de.
FAU - Wagner, Daniela
AU  - Wagner D
AD  - Department of Anaesthesiology, University Hospital Munich, LMU Munich, 
      Marchioninistrasse 15, 81377, Munich, Germany.
FAU - Kammerer, Tobias
AU  - Kammerer T
AD  - Department of Anaesthesiology, University Hospital Munich, LMU Munich, 
      Marchioninistrasse 15, 81377, Munich, Germany.
AD  - Department of Anaesthesiology and Intensive Care Medicine, University Hospital of 
      Cologne, Cologne, Germany.
FAU - Kellert, Lars
AU  - Kellert L
AD  - Department of Neurology, University Hospital Munich, LMU Munich, Munich, Germany.
FAU - Giebl, Andreas
AU  - Giebl A
AD  - Department of Transfusion Medicine and Hemostaseology, University Hospital 
      Augsburg, Augsburg, Germany.
FAU - Massberg, Steffen
AU  - Massberg S
AD  - Department of Internal Medicine I - Cardiology, University Hospital Munich, LMU 
      Munich, Munich, Germany.
FAU - Schafer, Simon Thomas
AU  - Schafer ST
AD  - Department of Anaesthesiology, University Hospital Munich, LMU Munich, 
      Marchioninistrasse 15, 81377, Munich, Germany.
LA  - eng
GR  - Thromboelastometric machines and reagents were provided by enicor GmbH (Munich, 
      Germany)./enicor GmbH/
PT  - Journal Article
DEP - 20210316
PL  - England
TA  - Thromb J
JT  - Thrombosis journal
JID - 101170542
PMC - PMC7962229
OTO - NOTNLM
OT  - Anticoagulants
OT  - Coagulation tests
OT  - Dabigatran
OT  - Factor Xa (FXa) inhibitors
OT  - Heparin
OT  - Viscoelastometry
COIS- 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.
EDAT- 2021/03/18 06:00
MHDA- 2021/03/18 06:01
PMCR- 2021/03/16
CRDT- 2021/03/17 05:45
PHST- 2020/11/24 00:00 [received]
PHST- 2021/03/01 00:00 [accepted]
PHST- 2021/03/17 05:45 [entrez]
PHST- 2021/03/18 06:00 [pubmed]
PHST- 2021/03/18 06:01 [medline]
PHST- 2021/03/16 00:00 [pmc-release]
AID - 10.1186/s12959-021-00267-w [pii]
AID - 267 [pii]
AID - 10.1186/s12959-021-00267-w [doi]
PST - epublish
SO  - Thromb J. 2021 Mar 16;19(1):18. doi: 10.1186/s12959-021-00267-w.