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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


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Volume 52, Issue 6

Issues

Dabigatran, rivaroxaban, apixaban, argatroban and fondaparinux and their effects on coagulation POC and platelet function tests

Thomas Eller
  • Institute of Laboratory Medicine, Microbiology Hygiene and Transfusion Medicine, Johannes Wesling Klinikum Minden, Minden, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jessica Busse
  • Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center, Ruhr University Bochum, Bad Oeynhausen, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Marcus Dittrich / Tobias Flieder
  • Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center, Ruhr University Bochum, Bad Oeynhausen, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Susanne Alban / Cornelius Knabbe
  • Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center, Ruhr University Bochum, Bad Oeynhausen, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ingvild Birschmann
  • Corresponding author
  • Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center, Ruhr University Bochum, Bad Oeynhausen, Germany
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2014-01-09 | DOI: https://doi.org/10.1515/cclm-2013-0936

Abstract

Background: In recent years, several selectively acting anticoagulants, including the direct thrombin inhibitors (DTI; argatroban, dabigatran) and the factor Xa inhibitors (rivaroxaban, apixaban, fondaparinux), have been developed. With their clinical application increasing, it is of interest to evaluate their interference with classical haemostaseological point-of-care tests. Additionally, the effect of the investigated anticoagulants on platelet function tests will come increasingly more into focus for monitoring not only hereditary platelet dysfunction, but also antiplatelet therapy.

Methods: Blood samples from healthy volunteers were spiked with therapeutic and supratherapeutic concentrations of the drugs listed above and investigated with regard to their effects on the following POCTs: activated clotting time (ACT), thromboelastometry with ROTEM®, PFA® and Multiplate®. Light-transmission aggregometry (LTA) was used for a platelet function assay.

Results: At supratherapeutic concentrations, ACT and ROTEM® analysis were always influenced after administration of the drugs listed above (except fondaparinux in EXTEM-CT). Therapeutic concentrations showed differential effects on these assays. LTA measurements revealed a distinct decrease in α-thrombin-induced platelet aggregation for both DTIs (therapeutic and supratherapeutic concentrations), while argatroban reduced platelet function in supratherapeutic concentrations. None of the drugs seemed to have any influence on PFA® or Multiplate®.

Conclusions: Selective thrombin and factor Xa inhibitors exhibit distinct effects on POCTs and platelet function tests. This must be considered in assessing assay results when taking medical decisions.

This article offers supplementary material which is provided at the end of the article.

Keywords: direct oral anticoagulants; direct thrombin inhibitors; platelets; point-of-care systems; preanalytics

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About the article

Corresponding author: Ingvild Birschmann, MD, PhD, Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center, Ruhr University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany, Phone: +49 5731 97-3819, Fax: +49 5731 97-2307, E-mail:

aThomas Eller and Jessica Busse contributed equally to this work.


Received: 2013-10-30

Accepted: 2013-12-05

Published Online: 2014-01-09

Published in Print: 2014-06-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 52, Issue 6, Pages 835–844, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2013-0936.

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