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Routine Coagulation Tests in Patients With Nonvalvular Atrial Fibrillation Under Dabigatran and Rivaroxaban Therapy:

Vanessa M Silva1, Maurício Scanavacca2, Francisco Darrieux2

  • 11 Clinical Laboratory Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|March 26, 2019
PubMed

Insights

Routine coagulation tests like aPTT and PT can help monitor direct oral anticoagulant (DOAC) levels for dabigatran and rivaroxaban. These tests aid in identifying subtherapeutic concentrations, improving patient therapy.

Area of Science:

  • Pharmacology
  • Clinical Chemistry
  • Hematology

Background:

  • Direct oral anticoagulants (DOACs) such as dabigatran and rivaroxaban are crucial for managing nonvalvular atrial fibrillation.
  • Understanding the impact of DOACs on routine coagulation tests is essential for effective therapeutic monitoring.
  • Variability in DOAC levels can affect patient outcomes and requires reliable monitoring methods.

Purpose of the Study:

  • To investigate the association between plasma concentrations of dabigatran and rivaroxaban and standard coagulation test results.
  • To evaluate the utility of routine coagulation tests in identifying therapeutic and subtherapeutic DOAC levels.
  • To establish correlations between specific DOACs and their effects on activated partial thromboplastin time (aPTT) and prothrombin time (PT).

Main Methods:

  • Patients with nonvalvular atrial fibrillation on dabigatran (150 mg) or rivaroxaban (20 mg) had blood samples collected 2 hours post-dose.
  • DOAC concentrations were measured using specific assays: Hemoclot thrombin inhibitor (HTI) for dabigatran and Anti-Xa-Riva for rivaroxaban.
  • Routine coagulation tests, including aPTT and PT, were performed on the collected samples.

Main Results:

  • The median dabigatran level was 128.3 ng/mL, with HTI assay showing a strong correlation with aPTT (R² = 0.74, P < .0001).
  • The median rivaroxaban level was 223.9 ng/mL; Anti-Xa-Riva correlated with PT (R² = 0.69, P < .0001) and aPTT (R² = 0.36, P < .001).
  • Prolonged PT was observed even below the therapeutic range for rivaroxaban, indicating routine tests can detect out-of-range concentrations.

Conclusions:

  • Routine coagulation tests, specifically aPTT for dabigatran and PT for rivaroxaban, demonstrate significant correlations with drug levels.
  • These screening tests are capable of identifying both supratherapeutic and subtherapeutic concentrations of dabigatran and rivaroxaban.
  • The findings support the use of aPTT and PT as valuable tools for monitoring DOAC therapy and ensuring optimal patient management.

Keywords:
activated partial thromboplastin timedabigatranprothrombin timerivaroxaban

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