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Direct oral anticoagulant plasma levels and thrombin generation on ST Genesia system.
Res Pract Thromb Haemost. 2020 May; 4(4):619-627.RP

Abstract

Background

Monitoring of anticoagulant activity of direct oral anticoagulants (DOACs) can be necessary in special situations. DOAC plasma levels have a high inter- and intraindividual variation and do not necessarily reflect the coagulation status of the patient. Thrombin generation (TG) is a global hemostatic assay with the capacity to overcome this limitation. The aim of this study was to show correlations between DOAC plasma levels and TG parameters using the fully automated ST Genesia system.

Methods

A total of 380 blood samples (120 with apixaban, 79 with dabigatran, 79 with edoxaban, and 102 with rivaroxaban) from patients at different time points after DOAC intake were included in the analysis. DOAC plasma levels were analyzed using calibrated anti-Xa or anti-IIa tests. Thrombin generation was measured using the ST Genesia system and STG-DrugScreen reagent.

Results

There was a significant correlation between the drug levels of all DOACs and the TG parameters' lag time and time to peak. Peak thrombin and velocity index show a negative correlation following an exponential regression curve with all anti-Xa DOACs but not with dabigatran. Apart from a weak correlation with rivaroxaban, there was no correlation between drug levels of all other DOACs and endogenous thrombin potential.

Conclusion

TG parameters measured with ST Genesia correlate with the drug levels of anti-Xa DOACs. Peak thrombin and velocity index are of special interest for the determination of residual anticoagulant effect at low drug levels. For dabigatran-treated patients, only lag time shows a correlation with the dabigatran plasma levels.

Authors+Show Affiliations

Division of Hemostaseology Medical Department I University Hospital Leipzig Leipzig Germany.Department of Cardiology University Hospital Leipzig Leipzig Germany.Division of Hemostaseology Medical Department I University Hospital Leipzig Leipzig Germany. Medical ICU University Hospital Leipzig Leipzig Germany.Department of Cardiology University Hospital Leipzig Leipzig Germany.Division of Hemostaseology Medical Department I University Hospital Leipzig Leipzig Germany. Medical ICU University Hospital Leipzig Leipzig Germany.Division of Hemostaseology Medical Department I University Hospital Leipzig Leipzig Germany. Medical ICU University Hospital Leipzig Leipzig Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32548561

Citation

Pfrepper, Christian, et al. "Direct Oral Anticoagulant Plasma Levels and Thrombin Generation On ST Genesia System." Research and Practice in Thrombosis and Haemostasis, vol. 4, no. 4, 2020, pp. 619-627.
Pfrepper C, Metze M, Siegemund A, et al. Direct oral anticoagulant plasma levels and thrombin generation on ST Genesia system. Res Pract Thromb Haemost. 2020;4(4):619-627.
Pfrepper, C., Metze, M., Siegemund, A., Klöter, T., Siegemund, T., & Petros, S. (2020). Direct oral anticoagulant plasma levels and thrombin generation on ST Genesia system. Research and Practice in Thrombosis and Haemostasis, 4(4), 619-627. https://doi.org/10.1002/rth2.12340
Pfrepper C, et al. Direct Oral Anticoagulant Plasma Levels and Thrombin Generation On ST Genesia System. Res Pract Thromb Haemost. 2020;4(4):619-627. PubMed PMID: 32548561.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Direct oral anticoagulant plasma levels and thrombin generation on ST Genesia system. AU - Pfrepper,Christian, AU - Metze,Michael, AU - Siegemund,Annelie, AU - Klöter,Tristan, AU - Siegemund,Thomas, AU - Petros,Sirak, Y1 - 2020/04/23/ PY - 2019/09/29/received PY - 2020/02/26/revised PY - 2020/03/02/accepted PY - 2020/6/18/entrez PY - 2020/6/18/pubmed PY - 2020/6/18/medline KW - DOAC plasma levels KW - ST Genesia KW - anti‐Xa‐inhibitors KW - correlation KW - dabigatran KW - thrombin generation SP - 619 EP - 627 JF - Research and practice in thrombosis and haemostasis JO - Res Pract Thromb Haemost VL - 4 IS - 4 N2 - Background: Monitoring of anticoagulant activity of direct oral anticoagulants (DOACs) can be necessary in special situations. DOAC plasma levels have a high inter- and intraindividual variation and do not necessarily reflect the coagulation status of the patient. Thrombin generation (TG) is a global hemostatic assay with the capacity to overcome this limitation. The aim of this study was to show correlations between DOAC plasma levels and TG parameters using the fully automated ST Genesia system. Methods: A total of 380 blood samples (120 with apixaban, 79 with dabigatran, 79 with edoxaban, and 102 with rivaroxaban) from patients at different time points after DOAC intake were included in the analysis. DOAC plasma levels were analyzed using calibrated anti-Xa or anti-IIa tests. Thrombin generation was measured using the ST Genesia system and STG-DrugScreen reagent. Results: There was a significant correlation between the drug levels of all DOACs and the TG parameters' lag time and time to peak. Peak thrombin and velocity index show a negative correlation following an exponential regression curve with all anti-Xa DOACs but not with dabigatran. Apart from a weak correlation with rivaroxaban, there was no correlation between drug levels of all other DOACs and endogenous thrombin potential. Conclusion: TG parameters measured with ST Genesia correlate with the drug levels of anti-Xa DOACs. Peak thrombin and velocity index are of special interest for the determination of residual anticoagulant effect at low drug levels. For dabigatran-treated patients, only lag time shows a correlation with the dabigatran plasma levels. SN - 2475-0379 UR - https://www.unboundmedicine.com/medline/citation/32548561/Direct_oral_anticoagulant_plasma_levels_and_thrombin_generation_on_ST_Genesia_system_ L2 - https://doi.org/10.1002/rth2.12340 DB - PRIME DP - Unbound Medicine ER -
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