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Poor comparability of coagulation screening test with specific measurement in patients receiving direct oral anticoagulants: results from a multicenter/multiplatform study.
J Thromb Haemost. 2016 11; 14(11):2194-2201.JT

Abstract

Essentials Prothrombin and partial thromboplastin time (PT/PTT) measure direct oral anticoagulants (DOACs). PT, PTT and specific tests for DOACs were performed on patients treated for atrial fibrillation. Normal PT/PTT don't exclude DOAC activity and their prolongation doesn't confirm DOAC action. The use of PT or PTT to evaluate DOAC activity could cause dangerous misinterpretations.

SUMMARY

Background Prothrombin time (PT) and activated partial thromboplastin time (APTT) have been proposed to measure the effect of oral anti-activated factor X (FXa) or anti-activated FII drugs, respectively. Aims To evaluate the relationships and responsiveness of PT and APTT versus direct oral anticoagulant (DOAC) concentrations measured with specific coagulation tests performed with different platforms in four Italian anticoagulation clinics. Methods Six hundred and thirty-five patients with atrial fibrillation participated in the study: 240 were receiving dabigatran, 264 were receiving rivaroxaban, and 131 were receiving apixaban. Blood was taken at trough and peak within the first month (15-25 days) of treatment. PT, APTT, diluted thrombin time (dTT) calibrated for dabigatran and anti-FXa calibrated for rivaroxaban or apixaban were determined. Results For dabigatran, the correlation between APTT and dTT ranged from r = 0.80 to r = 0.62. For rivaroxaban, the correlation between the anti-FXa assay and PT ranged from r = 0.91 to r = 0.73. For apixaban, the correlation between the anti-FXa assay and PT was lower than for the two other drugs (r = 0.81 to r = 0.54). Despite the above significant correlations, the responsiveness of PT or APTT was relatively poor. A discrepancy between global testing and DOAC plasma concentrations was shown in a considerable proportion of patients, depending on the platform and drug, with values ranging from 6% to 62%. Conclusions Overall, poor responsiveness of the screening tests to DOAC concentrations was observed. PT and APTT normal values cannot exclude DOAC anticoagulant activity, and PT or APTT prolongation is not always associated with DOAC anticoagulant effect as determined with specific tests.

Authors+Show Affiliations

Department of Laboratory Medicine, Hemostasis and Thrombosis Center, AO Istituti Ospitalieri, Cremona, Italy.Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy.Department of Clinical Sciences and Community Health, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Università degli Studi di Milano, IRCCS Cà Granda Maggiore Hospital Foundation, Milan, Italy.Department of Laboratory Medicine, Hemostasis and Thrombosis Center, AO Istituti Ospitalieri, Cremona, Italy.Department of Cardiothoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy.Thrombosis Center, Department of Heart and Vessels, University Hospital of Florence, Florence, Italy.Department of Laboratory Medicine, Hemostasis and Thrombosis Center, AO Istituti Ospitalieri, Cremona, Italy.Department of Laboratory Medicine, ULSS 16 and University-Hospital of Padova, Padova, Italy.Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy.Thrombosis Center, Department of Heart and Vessels, University Hospital of Florence, Florence, Italy.Thrombosis Center, Department of Heart and Vessels, University Hospital of Florence, Florence, Italy.Cardiovascular Diseases, University of Bologna, Bologna, Italy.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27566988

Citation

Testa, S, et al. "Poor Comparability of Coagulation Screening Test With Specific Measurement in Patients Receiving Direct Oral Anticoagulants: Results From a Multicenter/multiplatform Study." Journal of Thrombosis and Haemostasis : JTH, vol. 14, no. 11, 2016, pp. 2194-2201.
Testa S, Legnani C, Tripodi A, et al. Poor comparability of coagulation screening test with specific measurement in patients receiving direct oral anticoagulants: results from a multicenter/multiplatform study. J Thromb Haemost. 2016;14(11):2194-2201.
Testa, S., Legnani, C., Tripodi, A., Paoletti, O., Pengo, V., Abbate, R., Bassi, L., Carraro, P., Cini, M., Paniccia, R., Poli, D., & Palareti, G. (2016). Poor comparability of coagulation screening test with specific measurement in patients receiving direct oral anticoagulants: results from a multicenter/multiplatform study. Journal of Thrombosis and Haemostasis : JTH, 14(11), 2194-2201. https://doi.org/10.1111/jth.13486
Testa S, et al. Poor Comparability of Coagulation Screening Test With Specific Measurement in Patients Receiving Direct Oral Anticoagulants: Results From a Multicenter/multiplatform Study. J Thromb Haemost. 2016;14(11):2194-2201. PubMed PMID: 27566988.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Poor comparability of coagulation screening test with specific measurement in patients receiving direct oral anticoagulants: results from a multicenter/multiplatform study. AU - Testa,S, AU - Legnani,C, AU - Tripodi,A, AU - Paoletti,O, AU - Pengo,V, AU - Abbate,R, AU - Bassi,L, AU - Carraro,P, AU - Cini,M, AU - Paniccia,R, AU - Poli,D, AU - Palareti,G, Y1 - 2016/10/15/ PY - 2016/01/25/received PY - 2016/8/28/pubmed PY - 2018/1/4/medline PY - 2016/8/28/entrez KW - activated partial thromboplastin time KW - anticoagulant drugs KW - atrial fibrillation KW - blood coagulation test KW - prothrombin time SP - 2194 EP - 2201 JF - Journal of thrombosis and haemostasis : JTH JO - J. Thromb. Haemost. VL - 14 IS - 11 N2 - : Essentials Prothrombin and partial thromboplastin time (PT/PTT) measure direct oral anticoagulants (DOACs). PT, PTT and specific tests for DOACs were performed on patients treated for atrial fibrillation. Normal PT/PTT don't exclude DOAC activity and their prolongation doesn't confirm DOAC action. The use of PT or PTT to evaluate DOAC activity could cause dangerous misinterpretations. SUMMARY: Background Prothrombin time (PT) and activated partial thromboplastin time (APTT) have been proposed to measure the effect of oral anti-activated factor X (FXa) or anti-activated FII drugs, respectively. Aims To evaluate the relationships and responsiveness of PT and APTT versus direct oral anticoagulant (DOAC) concentrations measured with specific coagulation tests performed with different platforms in four Italian anticoagulation clinics. Methods Six hundred and thirty-five patients with atrial fibrillation participated in the study: 240 were receiving dabigatran, 264 were receiving rivaroxaban, and 131 were receiving apixaban. Blood was taken at trough and peak within the first month (15-25 days) of treatment. PT, APTT, diluted thrombin time (dTT) calibrated for dabigatran and anti-FXa calibrated for rivaroxaban or apixaban were determined. Results For dabigatran, the correlation between APTT and dTT ranged from r = 0.80 to r = 0.62. For rivaroxaban, the correlation between the anti-FXa assay and PT ranged from r = 0.91 to r = 0.73. For apixaban, the correlation between the anti-FXa assay and PT was lower than for the two other drugs (r = 0.81 to r = 0.54). Despite the above significant correlations, the responsiveness of PT or APTT was relatively poor. A discrepancy between global testing and DOAC plasma concentrations was shown in a considerable proportion of patients, depending on the platform and drug, with values ranging from 6% to 62%. Conclusions Overall, poor responsiveness of the screening tests to DOAC concentrations was observed. PT and APTT normal values cannot exclude DOAC anticoagulant activity, and PT or APTT prolongation is not always associated with DOAC anticoagulant effect as determined with specific tests. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/27566988/Poor_comparability_of_coagulation_screening_test_with_specific_measurement_in_patients_receiving_direct_oral_anticoagulants:_results_from_a_multicenter/multiplatform_study_ L2 - https://doi.org/10.1111/jth.13486 DB - PRIME DP - Unbound Medicine ER -