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Determination of non-Vitamin K oral anticoagulant (NOAC) effects using a new-generation thrombelastography TEG 6s system.

Publication ,  Journal Article
Bliden, KP; Chaudhary, R; Mohammed, N; Muresan, AA; Lopez-Espina, CG; Cohen, E; Raviv, G; Doubleday, M; Zaman, F; Mathew, B; Tantry, US; Gurbel, PA
Published in: J Thromb Thrombolysis
May 2017

Non vitamin K oral anticoagulants (NOACs) do not require regular monitoring but information about their pharmacodynamic effect may be importantin situations like trauma, stroke oremergent surgery. Currently, no standardized point-of-care test is available to evaluate the anticoagulant effects of NOACs. We evaluated the anticoagulant effect of NOACs with the next generation point-of-care TEG assay (TEG® 6S) based on a fully-automated thrombelastography system. We used two TEG® 6S assays, the DTI assay and Anti-Factor Xa (AFXa) assay, to detect anticoagulant effects and classify NOACs. Blood from healthy volunteers (n = 26) was used to obtain a baseline reference range. Data derived from patients on factor Xa inhibitors (FXi) (rivaroxaban and apixaban) (n = 39), and direct thrombin inhibitors (DTIs) (dabigatran) (n = 25) were compared against the reference range for detection of drug effect and drug classification. TEG®6s R-time highly correlated to each NOAC. Presence of NOACs caused elongation of R-time on the AFXa assay compared to the reference range (4.3 ± 1.7 vs. 1.3 ± 0.3 min. for FXi, p < 0.001 and 3.5 ± 1.2 vs. 1.3 ± 0.3 min. for DTI, p < 0.001). R-time on the DTI assay was elongated only in presence of a DTI (3.4 ± 1.0 vs. 1.5 ± 0.2 min, p < 0.001). The cutoff for detection of a DTI effect was an R time of 1.9 min and for anti-Xa effect was 1.95 min. For detection of NOAC therapy, there was ≥92% sensitivity and ≥95% specificity. The automated TEG®6s NOAC assay may be an effective tool to identify an anticoagulant effect from NOAC therapy and facilitate care of patients with bleeding or at risk of bleeding in the event of needing emergency surgery.

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Published In

J Thromb Thrombolysis

DOI

EISSN

1573-742X

Publication Date

May 2017

Volume

43

Issue

4

Start / End Page

437 / 445

Location

Netherlands

Related Subject Headings

  • Thrombelastography
  • Rivaroxaban
  • Pyridones
  • Pyrazoles
  • Point-of-Care Systems
  • Middle Aged
  • Male
  • Limit of Detection
  • Humans
  • Hemorrhage
 

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Bliden, K. P., Chaudhary, R., Mohammed, N., Muresan, A. A., Lopez-Espina, C. G., Cohen, E., … Gurbel, P. A. (2017). Determination of non-Vitamin K oral anticoagulant (NOAC) effects using a new-generation thrombelastography TEG 6s system. J Thromb Thrombolysis, 43(4), 437–445. https://doi.org/10.1007/s11239-017-1477-1
Bliden, Kevin P., Rahul Chaudhary, Nafees Mohammed, Adina A. Muresan, Carlos G. Lopez-Espina, Eli Cohen, Gabriel Raviv, et al. “Determination of non-Vitamin K oral anticoagulant (NOAC) effects using a new-generation thrombelastography TEG 6s system.J Thromb Thrombolysis 43, no. 4 (May 2017): 437–45. https://doi.org/10.1007/s11239-017-1477-1.
Bliden KP, Chaudhary R, Mohammed N, Muresan AA, Lopez-Espina CG, Cohen E, et al. Determination of non-Vitamin K oral anticoagulant (NOAC) effects using a new-generation thrombelastography TEG 6s system. J Thromb Thrombolysis. 2017 May;43(4):437–45.
Bliden, Kevin P., et al. “Determination of non-Vitamin K oral anticoagulant (NOAC) effects using a new-generation thrombelastography TEG 6s system.J Thromb Thrombolysis, vol. 43, no. 4, May 2017, pp. 437–45. Pubmed, doi:10.1007/s11239-017-1477-1.
Bliden KP, Chaudhary R, Mohammed N, Muresan AA, Lopez-Espina CG, Cohen E, Raviv G, Doubleday M, Zaman F, Mathew B, Tantry US, Gurbel PA. Determination of non-Vitamin K oral anticoagulant (NOAC) effects using a new-generation thrombelastography TEG 6s system. J Thromb Thrombolysis. 2017 May;43(4):437–445.
Journal cover image

Published In

J Thromb Thrombolysis

DOI

EISSN

1573-742X

Publication Date

May 2017

Volume

43

Issue

4

Start / End Page

437 / 445

Location

Netherlands

Related Subject Headings

  • Thrombelastography
  • Rivaroxaban
  • Pyridones
  • Pyrazoles
  • Point-of-Care Systems
  • Middle Aged
  • Male
  • Limit of Detection
  • Humans
  • Hemorrhage