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Diluted thrombin time reliably measures low to intermediate plasma dabigatran concentrations
Mojca Božič-Mijovski1, Rickard E Malmström2, Petra Malovrh3
1Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia mojca.bozic@kclj.si.
Annals of Clinical Biochemistry
|September 23, 2015
Summary
This study shows that diluted thrombin time reliably measures dabigatran levels in patients, outperforming other assays in the low to intermediate range. This method offers a valuable tool for monitoring direct oral anticoagulant therapy.
Area of Science:
- Pharmacology
- Clinical Chemistry
- Hematology
Background:
- Direct oral anticoagulants (DOACs) like dabigatran are increasingly used for anticoagulation.
- Routine coagulation monitoring is not standard for dabigatran, but estimating plasma drug levels is recommended.
- Diluted thrombin time (DTT) is a potential method for assessing dabigatran levels.
Purpose of the Study:
- To evaluate a DTT assay using a standard thrombin reagent for measuring low to intermediate dabigatran plasma levels.
- To compare the DTT assay's performance against established methods.
Main Methods:
- 44 atrial fibrillation patients on dabigatran (110mg or 150mg BID) were studied.
- Blood samples collected at baseline, trough, and peak during therapy.
- Plasma dabigatran levels measured by DTT and liquid chromatography-tandem mass spectrometry (LC-MS/MS).
Main Results:
- DTT showed high correlation with LC-MS/MS (Pearson's R=0.9799).
- In the low-intermediate range (≤100 µg/L), DTT was more accurate than Hemoclot® Thrombin Inhibitor and Ecarin Chromogenic Assay.
- DTT was the only functional assay without significant bias in this range.
Conclusions:
- The DTT assay reliably detects dabigatran in plasma.
- DTT demonstrates superiority over Hemoclot® Thrombin Inhibitor for monitoring low to intermediate dabigatran levels.
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