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Fully automated thromboelastograph TEG 6s to measure anticoagulant effects of direct oral anticoagulants in healthy male volunteers.
Res Pract Thromb Haemost. 2019 Jul; 3(3):391-396.RP

Abstract

Background

The ability to assess the hemostatic effect of the direct oral anticoagulant (DOACs) may be valuable in clinical situations such as bleeding or thrombosis, before urgent surgery, or reversal of anticoagulation. We sought to assess the anticoagulant effect of DOACs with the new-generation fully automated thrombelastograph TEG 6s using resonance-frequency viscoelasticity measurements and disposable multichannel microfluidic cartridges.

Methods

A single dose of oral dabigatran 150 mg, rivaroxaban 20 mg, or apixaban 5 mg was given to 9 healthy males. Phlebotomy was performed at 0, 1, and 3 hours after administration of DOAC. TEG parameters were measured using TEG _6s. Concentrations of DOACs were measured using chromogenic assays. The TEG parameters were correlated to the DOAC concentrations.

Results

The reaction time (R) demonstrated the strongest response to DOAC intake. There were no correlations between other TEG parameters and DOAC concentrations. Using the direct thrombin inhibitor (DTI) channel, R was significantly correlated with dabigatran levels (r = 0.94, P < 0.0001). Using the anti-factor Xa (AFXa) channel, R was significantly correlated with rivaroxaban and apixaban levels (r = 0.93 and r = 0.83, respectively; P < 0.0001 for both). R >2.5 minutes for dabigatran (DTI channel), >2.5 minutes for apixaban, and >1.8 minutes for rivaroxaban (AFXa channel) were associated with 100% sensitivity and ≥ 90% specificity to detect DOAC levels of ≥ 50 ng/mL.

Conclusion

We have demonstrated that TEG _6s R has significant correlation with DOAC blood concentrations and has potential for monitoring the DOAC's effect on hemostasis with reasonable sensitivity in the small sample analyzed. This novel technology is easy to use on a small volume of whole blood without requiring a specialized laboratory. Further study is warranted to correlate R with clinical outcomes.

Authors+Show Affiliations

Essentia Health St. Mary's Heart and Vascular Center Duluth Minnesota. Bispebjerg University Hospital University of Copenhagen Kobenhavn Denmark.Essentia Health St. Mary's Heart and Vascular Center Duluth Minnesota. University of Minnesota School of Medicine Minneapolis Minnesota.Bispebjerg University Hospital University of Copenhagen Kobenhavn Denmark.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31294326

Citation

Artang, Ramin, et al. "Fully Automated Thromboelastograph TEG 6s to Measure Anticoagulant Effects of Direct Oral Anticoagulants in Healthy Male Volunteers." Research and Practice in Thrombosis and Haemostasis, vol. 3, no. 3, 2019, pp. 391-396.
Artang R, Anderson M, Nielsen JD. Fully automated thromboelastograph TEG 6s to measure anticoagulant effects of direct oral anticoagulants in healthy male volunteers. Res Pract Thromb Haemost. 2019;3(3):391-396.
Artang, R., Anderson, M., & Nielsen, J. D. (2019). Fully automated thromboelastograph TEG 6s to measure anticoagulant effects of direct oral anticoagulants in healthy male volunteers. Research and Practice in Thrombosis and Haemostasis, 3(3), 391-396. https://doi.org/10.1002/rth2.12206
Artang R, Anderson M, Nielsen JD. Fully Automated Thromboelastograph TEG 6s to Measure Anticoagulant Effects of Direct Oral Anticoagulants in Healthy Male Volunteers. Res Pract Thromb Haemost. 2019;3(3):391-396. PubMed PMID: 31294326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fully automated thromboelastograph TEG 6s to measure anticoagulant effects of direct oral anticoagulants in healthy male volunteers. AU - Artang,Ramin, AU - Anderson,Maren, AU - Nielsen,Jorn D, Y1 - 2019/05/12/ PY - 2018/11/12/received PY - 2019/03/06/accepted PY - 2019/7/12/entrez PY - 2019/7/12/pubmed PY - 2019/7/12/medline KW - apixaban KW - dabigatran KW - direct oral anticoagulants KW - rivaroxaban KW - thromboelastography SP - 391 EP - 396 JF - Research and practice in thrombosis and haemostasis JO - Res Pract Thromb Haemost VL - 3 IS - 3 N2 - Background: The ability to assess the hemostatic effect of the direct oral anticoagulant (DOACs) may be valuable in clinical situations such as bleeding or thrombosis, before urgent surgery, or reversal of anticoagulation. We sought to assess the anticoagulant effect of DOACs with the new-generation fully automated thrombelastograph TEG 6s using resonance-frequency viscoelasticity measurements and disposable multichannel microfluidic cartridges. Methods: A single dose of oral dabigatran 150 mg, rivaroxaban 20 mg, or apixaban 5 mg was given to 9 healthy males. Phlebotomy was performed at 0, 1, and 3 hours after administration of DOAC. TEG parameters were measured using TEG _6s. Concentrations of DOACs were measured using chromogenic assays. The TEG parameters were correlated to the DOAC concentrations. Results: The reaction time (R) demonstrated the strongest response to DOAC intake. There were no correlations between other TEG parameters and DOAC concentrations. Using the direct thrombin inhibitor (DTI) channel, R was significantly correlated with dabigatran levels (r = 0.94, P < 0.0001). Using the anti-factor Xa (AFXa) channel, R was significantly correlated with rivaroxaban and apixaban levels (r = 0.93 and r = 0.83, respectively; P < 0.0001 for both). R >2.5 minutes for dabigatran (DTI channel), >2.5 minutes for apixaban, and >1.8 minutes for rivaroxaban (AFXa channel) were associated with 100% sensitivity and ≥ 90% specificity to detect DOAC levels of ≥ 50 ng/mL. Conclusion: We have demonstrated that TEG _6s R has significant correlation with DOAC blood concentrations and has potential for monitoring the DOAC's effect on hemostasis with reasonable sensitivity in the small sample analyzed. This novel technology is easy to use on a small volume of whole blood without requiring a specialized laboratory. Further study is warranted to correlate R with clinical outcomes. SN - 2475-0379 UR - https://www.unboundmedicine.com/medline/citation/31294326/Fully_automated_thromboelastograph_TEG_6s_to_measure_anticoagulant_effects_of_direct_oral_anticoagulants_in_healthy_male_volunteers_ L2 - https://doi.org/10.1002/rth2.12206 DB - PRIME DP - Unbound Medicine ER -
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