Point-of-care testing for emergency assessment of coagulation in patients treated with direct oral anticoagulants

• Published in: Critical care (London, England) England), 2017-02, Vol.21 (1), p.32-32, Article 32
• Main Authors: Ebner, Matthias, Birschmann, Ingvild, Peter, Andreas, Spencer, Charlotte, Härtig, Florian, Kuhn, Joachim, Blumenstock, Gunnar, Zuern, Christine S, Ziemann, Ulf, Poli, Sven
• Format: Article
• Language: English
• Subjects: Analysis; Anticoagulants (Medicine); Blood clotting disorders; Critical care; Dosage and administration; Drug therapy; Emergency medicine
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-017-1619-z

Point-of-care testing (POCT) of coagulation has been proven to be of great value in accelerating emergency treatment. Specific POCT for direct oral anticoagulants (DOAC) is not available, but the effects of DOAC on established POCT have been described. We aimed to determine the diagnostic accuracy of Hemochron® Signature coagulation POCT to qualitatively rule out relevant concentrations of apixaban, rivaroxaban, and dabigatran in real-life patients. We enrolled 68 patients receiving apixaban, rivaroxaban, or dabigatran and obtained blood samples at six pre-specified time points. Coagulation testing was performed using prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), and activated clotting time (ACT+ and ACT-low range) POCT cards. For comparison, laboratory-based assays of diluted thrombin time (Hemoclot) and anti-Xa activity were conducted. DOAC concentrations were determined by liquid chromatography-tandem mass spectrometry. Four hundred and three samples were collected. POCT results of PT/INR and ACT+ correlated with both rivaroxaban and dabigatran concentrations. Insufficient correlation was found for apixaban. Rivaroxaban concentrations at