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Screening test for direct oral anticoagulants with the dilute Russell viper venom time
Author(s) -
Pratt Jackie,
Crispin Philip
Publication year - 2018
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13050
Subject(s) - medicine , dabigatran , rivaroxaban , partial thromboplastin time , apixaban , prothrombin time , antithrombin , thrombin time , gastroenterology , coagulation , warfarin , heparin , atrial fibrillation
Abstract Objectives To evaluate the dilute Russell viper venom time (DRVVT) for the detection of direct‐acting oral anticoagulants (DOACs) and to investigate the effect of DOACS on coagulation assays. Methods Patients with DOACs and controls had plasma levels determined by an anti‐Xa assay and dilute thrombin clotting time (TCT). Levels were correlated with the DRVVT as well as TCT, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, protein C, protein S and antithrombin levels. The utility of the DRVVT for detecting clinically significant levels of DOACs was evaluated. Results There were 44 samples from patients taking dabigatran, 83 with rivaroxaban, 18 with apixaban and 55 controls. The PT and APTT failed to detect clinically significant doses of anticoagulants adequately. The TCT was increased in patients taking dabigatran and normal in controls and patients on FXa inhibitors. There was a linear correlation with all DOAC levels and the DRVVT, with moderate precision, but it showed high sensitivity (95%) and specificity (90%) for clinically significant DOAC levels. Conclusion The DRVVT detects clinically significant levels of DOACs and, in conjunction with the TCT, may be used as a screen for the presence and type of DOAC.