Related Experiment Video
Updated: Mar 20, 2026
06:28
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
7.4K
Advancing Point-of-Care Analysis: The Future of Thromboelastographic DOAC-Detection: A Systematic Review
Gerrit U Herpertz1, Johannes Altmann1, Sven Poli2,3
1Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Oldenburg, Germany.
Seminars in Thrombosis and Hemostasis
|March 18, 2026
Summary
Modified viscoelastic testing (VET) assays show promise for rapidly detecting direct oral anticoagulants (DOACs) in emergencies. Ecarin tests reliably detect dabigatran, while other modified VET assays show potential for factor Xa inhibitors.
Area of Science:
- Clinical Chemistry and Hematology
- Pharmacology and Toxicology
- Point-of-Care Diagnostics
Background:
- Direct oral anticoagulants (DOACs) are increasingly used, necessitating rapid activity assessment in emergencies.
- Conventional viscoelastic testing (VET) lacks sensitivity for DOAC detection.
- Novel VET assays with specific activators are being developed for DOAC monitoring.
Purpose of the Study:
- To systematically review recent advances in VET-based DOAC detection.
- To evaluate the diagnostic performance of novel assay strategies.
- To assess the correlation between VET assay results and plasma DOAC concentrations.
Main Methods:
- Systematic literature search of PubMed and Google Scholar (January 2019-June 2025).
- Inclusion of 12 studies meeting PRISMA 2020 recommendations.
- Analysis of modified VET assays, including ecarin-based, Russell's Viper Venom, factor Xa-based, and low-tissue-factor activation methods.
Main Results:
- Ecarin-based assays showed 100% sensitivity and specificity for dabigatran.
- Modified assays for factor Xa inhibitors demonstrated variable but good correlation with drug levels (r=0.571-0.969).
- Sensitivities for factor Xa inhibitors ranged from 83% (apixaban) to 100% (rivaroxaban, edoxaban), with specificities of 62-100%.
Conclusions:
- Modified VET assays offer potential as rapid point-of-care tools for DOAC detection in emergency settings.
- Ecarin-based tests are reliable for dabigatran; Russell's Viper Venom and low-tissue-factor assays show promise for factor Xa inhibitors.
- Further clinical validation and standardization are essential for routine implementation.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
630
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
630
01:18Effects of EDTA on End-Point Detection Methods
741
Different methods, such as visual observance of metal-ion indicators, spectroscopic techniques, and potentiometric methods, can determine the endpoint of an EDTA titration.
In the visual method, metal-ion indicators (metallochromic dyes), which have distinct colors in their free and complex forms, are added to the mixture to signal the titration's end point. They form stable complexes with metal ions, but these complexes are weaker than the corresponding metal–EDTA complexes. As a...
In the visual method, metal-ion indicators (metallochromic dyes), which have distinct colors in their free and complex forms, are added to the mixture to signal the titration's end point. They form stable complexes with metal ions, but these complexes are weaker than the corresponding metal–EDTA complexes. As a...
741
01:26Therapeutic Drug Monitoring: Drug Analysis Methods
276
Therapeutic Drug Monitoring (TDM) is a clinical practice that measures specific drug levels in a patient's blood or body tissues to tailor drug therapy effectively. This monitoring is critical for managing drugs with narrow therapeutic indices like digoxin and phenytoin, ensuring they are both safe and effective. For instance, monitoring theophylline levels in asthma patients involves precision and sensitivity to adjust doses according to individual responses to therapy, ensuring efficacy and...
276
01:19Assessing Blood pressure using a doppler ultrasound
2.8K
To obtain accurate blood pressure measurements in clinical settings, especially when traditional methods are insufficient, healthcare professionals utilize the Doppler ultrasound technique. This method uses high-frequency sound waves to detect blood flow within the arteries, which is crucial for patients with conditions that complicate circulatory system assessment.
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
2.8K
01:30Acute Coronary Syndrome III: Diagnostic Studies
389
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
389
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
422
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
422