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A single test to assay warfarin, dabigatran, rivaroxaban, apixaban, unfractionated heparin, and enoxaparin in plasma
Author(s) -
Letertre L. R.,
Gudmundsdottir B. R.,
Francis C. W.,
Gosselin R. C.,
Skeppholm M.,
Malmstrom R. E.,
Moll S.,
Hawes E.,
Francart S.,
Onundarson P. T.
Publication year - 2016
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13300
Subject(s) - rivaroxaban , dabigatran , apixaban , serial dilution , warfarin , medicine , heparin , anticoagulant , prothrombin time , partial thromboplastin time , fondaparinux , pharmacology , coagulation , atrial fibrillation , thrombosis , venous thromboembolism , alternative medicine , pathology
Essentials Simple and fast assaying of different anticoagulants (ACs) is useful in emergent situations. We used highly diluted prothrombin time (dPT) or highly diluted Fiix‐PT (dFiix‐PT) to assay ACs. Both tests could quantify target specific anticoagulants and warfarin anticoagulation. Improved results were consistently observed with the dFiix‐PT compared with the dPT.Summary Background Assaying anticoagulants is useful in emergency situations or before surgery. Different specific assays are currently needed depending on the anticoagulant. Objectives We hypothesized that levels of warfarin, dabigatran, rivaroxaban, apixaban, and heparins could be measured with use of the diluted prothrombin time ( dPT ) and diluted Fiix‐ PT ( dF iix‐ PT ), using highly diluted thromboplastin ( TP ). The latter test is affected only by reduced levels of active factors II and X but corrects test plasma for other deficiencies Methods Increasing TP dilutions were used to identify suitable dilutions to measure dabigatran, rivaroxaban, apixaban, unfractionated heparin (UFH), and enoxaparin. Calibrators containing known amounts of direct oral anticoagulants ( DOAC s) were used to make standard curves. Citrated plasma samples were obtained from patients taking warfarin or DOAC s with known drug concentrations as determined by specific assays. Results The dF iix‐ PT at a TP dilution of 1:1156 could be used to measure all of the drugs tested at therapeutic concentrations except for fondaparinux. The dPT achieved the same but required two TP dilutions (1:750 and 1:300). The warfarin effect could be assessed by using dF iix‐ PT at 1:1156 with a PT ratio identical to the international normalized ratio. Six different TP s yielded similar results, but two were less sensitive. Dabigatran, rivaroxaban, and apixaban could be accurately measured in patient samples using both dilute PT assays, but a better correlation was consistently observed between the dF iix‐ PT and specific assays than with the dPT . Conclusion The dF iix‐ PT using a single dilution of TP may be suitable to assess the anticoagulant effects of warfarin, dabigatran, rivaroxaban, apixaban, heparin, and enoxaparin.