Related Experiment Video

Updated: Sep 13, 2025

Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
06:28

Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization

Published on: June 4, 2020

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[Use of thromboelastography prior to systemic thrombolysis in patients treated with DOACs - case series]

Lóránd Hegyi1, Péter Klivényi1,2, Alex Beke1

  • 1Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Neurológiai Klinika, Szeged.

Ideggyogyaszati Szemle
|July 28, 2025
PubMed

Insights

Direct oral anticoagulants (DOACs) complicate acute ischemic stroke treatment. Viscoelastic tests like RVV and ECA rapidly assess DOAC effect, aiding thrombolysis decisions in patients with unknown anticoagulant history.

Area of Science:

  • Cardiology
  • Neurology
  • Hematology

Background:

  • Direct oral anticoagulants (DOACs) are increasingly used, posing challenges for acute ischemic stroke management.
  • Thrombolysis is contraindicated within 48 hours of DOAC intake, necessitating accurate compliance assessment.
  • Accurate patient history of DOAC use is often unavailable, complicating treatment decisions.

Observation:

  • Viscoelastic tests, specifically Russell's viper venom (RVV) and Ecarin assay (ECA), were performed using a thromboelastograph.
  • These tests were applied to 25 acute ischemic stroke patients with uncertain DOAC history.
  • The tests provided information on anticoagulant effect and patient compliance based on coagulation time.

Findings:

  • DOAC therapy ineffectiveness was observed in 11 cases, with 9 confirmed by heteroanamnesis.
  • Thrombolysis was enabled in 4 patients based on test results.
  • One hemorrhagic complication occurred, linked to undiagnosed chronic lymphocytic leukemia.

Implications:

  • DOAC-specific viscoelastic tests (RVV, ECA) offer rapid assessment of recent DOAC intake (within 48 hours).
  • These tests facilitate identification of eligible patients for thrombolysis.
  • The assays assist clinicians in determining compliance, assessing thrombolysis possibility, and expediting treatment decisions.

Keywords:
DOACECA assayRVV assaythromboelastographthrombolysis

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