Real-time detection and differentiation of direct oral anticoagulants (rivaroxaban and dabigatran) using modified thromboelastometric reagents

摘要: Abstract Introduction Timely measurement of direct oral anticoagulants (DOACs) is challenging, though clinically important. We tested the hypotheses, that thromboelastometry able to detect dabigatran and rivaroxaban discriminates between as representatives two groups DOACs. Methods materials conducted a prospective-observational study: In-vitro dose-effect-curves for were performed (n = 10). Ex-vivo: Patients with indication DOAC treatment (stroke; dabigatran/rivaroxaban) included (n = 21). Blood samples analyzed before first intake, at estimated peak level 24 h after but following intake 3 h 24 h-intake. Standard modified thromboelastometric-assays, using low tissue factor concentrations (TFTEM) or ecarin (ECATEM) used. Receiver-operating-characteristics-curve-analysis (ROC), regression-analysis two-way-ANOVA performed. Results In-vitro: TFTEM detected (ROC_AUC: 0.99; sensitivity/specificity: 100%/98%) could not discriminate. Dabigatran prolongs CTECATEM whereas did not. Clotting Time (CT)-ratio TFTEM/ECATEM discriminated highly sensitive (100%) specific even very (ROC_AUC:1.0). correlated spiked (r = 0.9985; p  Conclusion The thromboelastometric tests ECATEM differentiate dabigatran. Further investigations evaluate other DOACs differentiation phenprocoumon. However, results need be confirmed in larger study, especially cut off values calculated from sample size.