Kunihiko Nagakari1, Mari Emmi2, Toshiaki Iba3. 1. 1 Department of Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan. 2. 2 Scientific and Technical Support Department, Kyowa Medex Co, Ltd, Tokyo, Japan. 3. 3 Department of Emergency and Disaster Medicine, Juntendo University School of Medicine, Bunkyo-ku, Japan.
Abstract
INTRODUCTION: The prompt assessment and the reversal of direct oral anticoagulants (DOACs) are urgent matters in the emergency care setting. Thus, we planned to elucidate the adequate prothrombin time (PT) test for the evaluation of the anticoagulant effects of various DOACs. METHODS: The anticoagulant effects of rivaroxaban, apixaban, and edoxaban were measured with 3 PT tests (Triniclot PT Excel S, Neoplastin R, and Thromborel S). Human plasma was spiked with each DOAC at a range of 0 to 1000 ng/mL, and the PT was measured using each PT test. In another series, the reversal effect of either 4-factor prothrombin complex concentrate (PCC) or activated PCC (aPCC) was evaluated with each PT test. RESULTS: All PT reagents correlated with the concentrations of each DOAC, however, the reactivity was considerably different between the DOACs and the PT tests. A prolonged PT with DOACs was reversed both by PCC and aPCC in a dose-dependent manner; however, Triniclot PT Excel S showed reprolongation of the PT with a higher dose of PCC. CONCLUSION: The proper choice of PT test is necessary for the assessments of the anticoagulant activity of DOACs. It is also important to understand the different characteristics of each PT test for the assessment of the reversal effects of PCC.
INTRODUCTION: The prompt assessment and the reversal of direct oral anticoagulants (DOACs) are urgent matters in the emergency care setting. Thus, we planned to elucidate the adequate prothrombin time (PT) test for the evaluation of the anticoagulant effects of various DOACs. METHODS: The anticoagulant effects of rivaroxaban, apixaban, and edoxaban were measured with 3 PT tests (Triniclot PT Excel S, Neoplastin R, and Thromborel S). Human plasma was spiked with each DOAC at a range of 0 to 1000 ng/mL, and the PT was measured using each PT test. In another series, the reversal effect of either 4-factor prothrombin complex concentrate (PCC) or activated PCC (aPCC) was evaluated with each PT test. RESULTS: All PT reagents correlated with the concentrations of each DOAC, however, the reactivity was considerably different between the DOACs and the PT tests. A prolonged PT with DOACs was reversed both by PCC and aPCC in a dose-dependent manner; however, Triniclot PT Excel S showed reprolongation of the PT with a higher dose of PCC. CONCLUSION: The proper choice of PT test is necessary for the assessments of the anticoagulant activity of DOACs. It is also important to understand the different characteristics of each PT test for the assessment of the reversal effects of PCC.
Entities:
Keywords:
antifactor Xa activity; apixaban; edoxaban; prothrombin time; rivaroxaban
Authors: Vepusha Sathanantham; Lorenzo Alberio; Cédric Bovet; Pierre Fontana; Bernhard Gerber; Lukas Graf; Adriana Mendez; Thomas C Sauter; Adrian Schmidt; Jan-Dirk Studt; Walter A Wuillemin; Michael Nagler Journal: Life (Basel) Date: 2022-07-11