171 results match your criteria doac plasma


Impact of centrifugation time and pneumatic tube transport on plasma concentrations of direct oral anticoagulants.

Int J Lab Hematol 2021 Oct 12. Epub 2021 Oct 12.

Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.

Introduction: Rapid results are needed when plasma concentrations of direct oral anticoagulants (DOACs) are required in acute clinical settings. We evaluated the impact of centrifugation time and pneumatic tube transport on DOAC plasma concentrations with the overall aim of reducing turnaround time.

Methods: Blood samples were spiked with rivaroxaban, apixaban or dabigatran in a low and a high concentration prior to centrifugation for 25 minutes (3163 g) or 5 minutes (3000 g) (n = 20 for each DOAC). Read More

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October 2021

Development and validation of an ultra-high performance liquid chromatography with tandem mass spectrometry method for the simultaneous quantification of direct oral anticoagulants in human plasma.

J Chromatogr B Analyt Technol Biomed Life Sci 2021 Oct 21;1182:122952. Epub 2021 Sep 21.

Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200040, PR China. Electronic address:

Direct oral anticoagulants are widely used to treat and prevent thromboembolic disorders. With rising clinical application, monitoring concentrations of direct oral anticoagulants are necessary in certain clinical conditions. A rapid and sensitive ultra-performance liquid chromatography-tandem mass spectrometry method was developed for the simultaneous determination of dabigatran etexilate, dabigatran, rivaroxaban, edoxaban, and apixaban, in human plasma. Read More

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October 2021

Influence of direct oral anticoagulants on thrombin generation on Ceveron TGA.

Int J Lab Hematol 2021 Sep 29. Epub 2021 Sep 29.

Division of Hemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany.

Introduction: Monitoring of direct oral anticoagulants (DOACs) with calibrated anti-Xa assay is limited by the high intra- and interindividual variations of the test results. Thrombin generation (TG) is a global hemostatic assay that reflects the patient´s individual coagulation status. The aim of this study was to investigate the influence of DOACs on TG measured with a fully automated assay system. Read More

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September 2021

Antithrombotic therapy for ambulatory patients with multiple myeloma receiving immunomodulatory agents.

Cochrane Database Syst Rev 2021 09 28;9:CD014739. Epub 2021 Sep 28.

Faculty of Medicine, American University of Beirut, Beirut, Lebanon.

Background: Multiple myeloma is a malignant plasma cell disorder characterised by clonal plasma cells that cause end-organ damage such as renal failure, lytic bone lesions, hypercalcaemia and/or anaemia. People with multiple myeloma are treated with immunomodulatory agents including lenalidomide, pomalidomide, and thalidomide. Multiple myeloma is associated with an increased risk of thromboembolism, which appears to be further increased in people receiving immunomodulatory agents. Read More

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September 2021

Automated Thrombin Generation Assay for Rivaroxaban, Apixaban, and Edoxaban Measurements.

Front Cardiovasc Med 2021 9;8:717939. Epub 2021 Sep 9.

Department of Clinical Chemistry, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.

The thrombin generation assay (TG) is a promising approach to measure the degree of anticoagulation in patients treated with direct oral anticoagulants (DOAC). A strong association with plasma drug concentrations would be a meaningful argument for the potential use to monitor DOAC. We aimed to study the correlation of TG with rivaroxaban, apixaban, and edoxaban drug concentrations in a large, prospective multicenter cross-sectional study. Read More

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September 2021

Reversal of direct oral anticoagulants in adult hip fracture patients. A systematic review and meta-analysis.

Injury 2021 Sep 12. Epub 2021 Sep 12.

Professor and Consultant Anaesthetist, Anaesthesia and Critical Care, Division of Clinical Neuroscience, University of Nottingham, UK Department of Anaesthesia, Nottingham University Hospitals, UK. Electronic address:

Background: Increasing numbers of patients are taking Direct Oral Anticoagulants at the time of hip fracture. Evidence is limited on how and if the effects of DOAC's should be reversed before surgical fixation. Wide variations in practice exist. Read More

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September 2021

Using a low-molecular weight heparin-calibrated anti-factor Xa assay to assess the concentration of apixaban and rivaroxaban.

Int J Lab Hematol 2021 Sep 15. Epub 2021 Sep 15.

Department of Molecular Medicine and Surgery, Karolinska Institutet & Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden.

Introduction: Direct oral anticoagulant (DOAC)-inhibiting factor Xa (FXa-DOAC) are being increasingly used as prophylaxis of venous thromboembolism and for prevention of stroke in patients with atrial fibrillation. In contrast to vitamin K antagonists, DOACs do not require monitoring in general. However, it is sometimes of value in the acute setting, for instance when considering a reversal agent in uncontrolled bleeding in patients on DOAC. Read More

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September 2021

Direct (new) oral anticoagulants (DOACs): Drawbacks, bleeding and reversal.

Cardiovasc Hematol Agents Med Chem 2021 Sep 13. Epub 2021 Sep 13.

Emergency Physician, M.D., University of Health Sciences, Dept. of Emergency Medicine, Haseki Education and Research Hospital, Fatih, Istanbul. Turkey.

Background And Objective: Direct (new) Oral Anticoagulants (DOACs) have emerged as a contemporary and promising option in the treatment of thromboses and VTE, while protecting the coagulation cascade against untoward bleeding events. They are used in the management and prophylaxis of Venous Thromboembolism (VTE) and other thrombotic diseases. The most prominent complication of these agents is bleeding. Read More

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September 2021

Direct oral anticoagulant plasma levels in hospitalized COVID-19 patients treated with dexamethasone.

J Thromb Thrombolysis 2021 Sep 8. Epub 2021 Sep 8.

Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.

Direct oral anticoagulants (DOACs) are not recommended in COVID-19 patients receiving dexamethasone because of potential drug-drug and drug-disease interactions affecting anticoagulant concentration and activity. To evaluate short- and long-term pharmacokinetic interactions, serial through and peak DOAC plasma levels were prospectively measured during and after dexamethasone therapy, as well as during the acute phase and after recovery from COVID-19 in hospitalized, non-critically ill patients undergoing treatment with DOACs. Thirty-three (18 males, mean age 79 years) consecutive patients received DOACs (17 apixaban, 12 rivaroxaban, 4 edoxaban) for atrial fibrillation (n = 22), venous thromboembolism (n = 10), and acute myocardial infarction (n = 1). Read More

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September 2021

Point of care whole blood microfluidics for detecting and managing thrombotic and bleeding risks.

Lab Chip 2021 09 28;21(19):3667-3674. Epub 2021 Sep 28.

Institute for Medicine and Engineering, Department of Chemical and Biomolecular Engineering, University of Pennsylvania, 1024 Vagelos Research Laboratory, Philadelphia, PA 19104, USA.

Point-of-care diagnostics of platelet and coagulation function present demanding challenges. Current clinical diagnostics often use centrifuged plasmas or platelets and frozen plasma standards, recombinant protein standards, or even venoms. Almost all commercialized tests of blood do not recreate the hemodynamics where platelets accumulate to high densities and thrombin is generated from a procoagulant surface. Read More

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September 2021

Impact of Idarucizumab and Andexanet Alfa on DOAC Plasma Concentration and ClotPro Clotting Time: An Ex Vivo Spiking Study in A Cohort of Trauma Patients.

J Clin Med 2021 Aug 6;10(16). Epub 2021 Aug 6.

AUVA Trauma Centre Salzburg, Department of Anaesthesiology and Intensive Care Medicine, Academic Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria.

Specific antagonists have been developed for the reversal of direct oral anticoagulants (DOAC). We investigated the impact of these reversal agents on the plasma concentration and visco-elastic test results of dabigatran and factor Xa inhibitors. After baseline measurements of dabigatran, the plasma concentration, and the visco-elastic ClotPro ecarin clotting time (ECA-CT), we added the reversal agent Idarucizumab in vitro and these two analyses were repeated. Read More

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A retrospective study of indications and consequences of monitoring direct oral anticoagulant plasma concentrations on patient care in a university hospital: The Retro-AOD study.

Thromb Res 2021 Oct 18;206:76-83. Epub 2021 Aug 18.

CHU Bordeaux, Service d'Anesthésie-Réanimation Tripode, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, Biologie des maladies cardiovasculaire, U1034, F-33600 Pessac, France. Electronic address:

Introduction: The use of direct oral anticoagulants (DOAC) is increasing. Specific concentrations are available and have been proven to be reliable and reproducible in optimising patient care. This retrospective, monocentric study aimed to describe the indications and consequences of monitoring DOAC plasma levels on patient care. Read More

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October 2021

Pharmacokinetics of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Extreme Obesity.

Clin Ther 2021 Aug 5. Epub 2021 Aug 5.

Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Fatebenefratelli-Sacco University Hospital, Università di Milano, Milano, Italy; Scientific Institute IRCCS Eugenio Medea, Lecco, Italy.

Purpose: Direct oral anticoagulants (DOACs) are recommended in preference to vitamin K antagonists (VKAs) for stroke prevention in patients with atrial fibrillation (AF) eligible for oral anticoagulation therapy; however, data and clinical experiences supporting the use of DOACs in patients with a body mass index ≥40 kg/m or weight >120 kg remain limited. The aim of this study was to evaluate the pharmacokinetic properties of DOACs in patients with AF and extreme obesity.

Methods: We enrolled all consecutive patients with AF and extreme obesity undergoing treatment with DOACs followed up at Monaldi Hospital, Naples, Italy. Read More

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Effect on Plasma Protein S Activity in Patients Receiving the Factor Xa Inhibitors.

J Atheroscler Thromb 2021 Jul 30. Epub 2021 Jul 30.

Department of Clinical Laboratory Science, Division of Health Sciences, Graduate School of Medical Science, Kanazawa University.

Aims: Measurement of protein S (PS) activity in patients taking direct oral anticoagulants (DOACs) using reagents based on a clotting assay results in falsely high PS activity, thus masking inherited PS deficiency, which is most frequently seen in the Japanese population. In this study, we investigated the effect of factor Xa (FXa) inhibitors on PS activity using the reagent on the basis of the chromogenic assay, which was recently developed in Japan.

Methods: The study enrolled 152 patients (82 males and 70 females; the average age: 68. Read More

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Causes of an elevated international normalized ratio in the intensive care unit and the implications for plasma transfusion.

Transfusion 2021 Oct 22;61(10):2862-2868. Epub 2021 Jul 22.

Department of Coagulation and Transfusion Medicine, The Miriam Hospital, Providence, Rhode Island, USA.

Background: The presence of an elevated international normalized ratio (INR) is common in patients in the intensive care unit (ICU), but the cause rarely determined. These patients are at risk to receive prophylactic plasma prior to invasive procedures.

Study Design And Methods: Samples from patients with an INR of 1. Read More

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October 2021

Evaluation of the in vitro stability of direct oral anticoagulants in blood samples under different storage conditions.

Scand J Clin Lab Invest 2021 Oct 18;81(6):461-468. Epub 2021 Jul 18.

Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy.

In this study, we evaluated the stability of direct oral anticoagulants (DOACs) in blood samples of 57 patients under different storage conditions using functional coagulation assays. We determined the analyte concentrations (1) immediately after blood collection (baseline); (2) after storage of citrated whole blood (agitated) at room temperature and citrated plasma at room temperature and at 4 °C for 4, 8, and 24 h, respectively; and (3) after storage of citrated plasma at -20 °C for 30, 60, and 90 days. According to the concept of acceptable change limits (ACL), analytes were considered stable if the mean relative analyte recovery at a given time was >78%. Read More

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October 2021

Direct Oral Anticoagulants Plasma Levels in Patients with Atrial Fibrillation at the Time of Bleeding: A Pilot Prospective Study.

J Cardiovasc Pharmacol 2021 07;78(1):e122-e127

Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic; and.

Abstract: Patients with atrial fibrillation (AF) on long-term direct oral anticoagulants (DOACs) may be at higher risk of bleeding because of higher anti-Xa or anti-IIa levels. However, there is no postmarketing study investigating these DOAC plasma levels at the time of bleeding. The aim of this study was to evaluate DOAC levels at the time of a bleeding emergency. Read More

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A Diagnostic Solution for Lupus Anticoagulant Testing in Patients Taking Direct Oral FXa Inhibitors Using DOAC Filter.

Front Med (Lausanne) 2021 31;8:683357. Epub 2021 May 31.

Service d'Hématologie Biologique, AP-HP, Center-Université de Paris, Hôpital Cochin, Paris, France.

Direct oral factor Xa (FXa) inhibitors interfere with lupus anticoagulant (LA) assays challenging antiphospholipid syndrome diagnosis in treated patients. We evaluated a new device, called DOAC Filter, and its usefulness in this setting. It is a single-use filtration cartridge in which FXa inhibitor compounds are trapped by non-covalent binding while plasma is filtered through a solid phase. Read More

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Plasma levels do not predict thrombin generation in patients taking direct oral anticoagulants.

Int J Lab Hematol 2021 Jun 7. Epub 2021 Jun 7.

Division of Hemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany.

Background: The antithrombotic effect of direct oral anticoagulants (DOAC) in specific clinical scenarios is difficult to assess.

Objective: This study aimed to evaluate the effect of DOAC on thrombin generation (TG) in relation to their plasma level.

Methods: Eighty patients newly started on anticoagulation were included, 20 patients for each DOAC-apixaban, edoxaban, rivaroxaban, and dabigatran. Read More

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Laboratory assessment of the direct oral anticoagulants: who can benefit?

Kardiol Pol 2021 24;79(6):622-630. Epub 2021 May 24.

Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.

Direct oral anticoagulants (DOACs), apixaban, dabigatran, edoxaban, and rivaroxaban, are widely used for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation as well as for prevention and treatment of venous thromboembolism. Although DOACs do not require routine laboratory monitoring of anticoagulant effect, there are special situations in which laboratory assessment may be warranted. Laboratory tests include quantitative assays, which measure plasma DOAC levels, and qualitative or semi-quantitative assays, which may be used to screen for the presence of clinically relevant DOAC levels. Read More

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How lower doses of direct oral anticoagulants are interpreted in clinical practice: a national survey of the Italian Atherosclerosis, Thrombosis and Vascular Biology (ATVB) Study Group.

J Cardiovasc Med (Hagerstown) 2021 Apr 28. Epub 2021 Apr 28.

Department of Cardiovascular Diseases - AUSL Romagna, Division of Cardiology, S. Maria delle Croci Hospital, Ravenna Department of Cardiothoracic Sciences, Division of Cardiology, S. Maria della Misericordia Hospital, Udine Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia Institute of Pharmacology, Catholic University School of Medicine, Rome Department of Cardiovascular Diseases, Division of Cardiology, Fondazione Poliambulanza, Brescia Division of Emergency Medicine and Surgery, S. Anna and S. Sebastiano Hospital, Caserta Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.

Aim: To evaluate the current interpretation of the lower doses of direct oral anticoagulants (DOAC) dabigatran, apixaban, edoxaban and rivaroxaban in nonvalvular atrial fibrillation.

Methods: A questionnaire of 14 statements to which the possible answers were fully agree/partially agree/partially disagree/fully disagree or yes/no was prepared within the board of the Italian Atherosclerosis, Thrombosis and Vascular Biology Study Group and forwarded to individual Italian physicians.

Results: A total of 620 complete questionnaires were received from nearly all the Italian regions and physicians of various medical specialists, either enabled or not for the prescription of DOAC. Read More

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Laboratory Monitoring of Direct Oral Anticoagulants (DOACs).

Authors:
Claire Dunois

Biomedicines 2021 Apr 21;9(5). Epub 2021 Apr 21.

HYPHEN BioMed, Sysmex Group, 95000 Neuville sur Oise, France.

The introduction of direct oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, apixaban, edoxaban, and betrixaban, provides safe and effective alternative to previous anticoagulant therapies. DOACs directly, selectively, and reversibly inhibit factors IIa or Xa. The coagulation effect follows the plasma concentration-time profile of the respective anticoagulant. Read More

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The effect of hemoadsorption on rivaroxaban blood plasma concentration in emergency cardiac surgery.

Indian J Thorac Cardiovasc Surg 2021 Apr 23:1-4. Epub 2021 Apr 23.

Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.

Hemoadsorption was used in a 59-year-old patient with an acute type A aortic dissection, who was on rivaroxaban and dual antiplatelet therapy with clopidogrel and acetylsalicylic acid. Our aim was to expeditiously remove rivaroxaban preoperatively. After 8 h of hemoadsorption, the rivaroxaban blood plasma concentration (RBPC) did not decrease below 42. Read More

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Idarucizumab (Praxbind) for dabigatran reversal in patients undergoing heart transplantation: a cohort of ten patients.

Future Sci OA 2021 Feb 15;7(4):FSO689. Epub 2021 Feb 15.

Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, 34295, France.

Background: Novel oral anticoagulants are used in atrial fibrillation. Idarucizumab has been approved for reversal of dabigatran in situations of life-threatening hemorrhage or emergency surgery.

Objectives: We report a single center experience of ten patients on dabigatran therapy who were given idarucizumab prior to heart transplantation. Read More

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February 2021

Partial warfarin reversal prior to hip fracture surgical intervention in geriatric trauma patients effects on blood loss and transfusions.

J Clin Orthop Trauma 2021 Mar 28;14:45-51. Epub 2020 Sep 28.

Injury Outcomes Network (ION) Research, 501 E. Hampden Ave, Englewood, CO, 80113, USA.

Background: Warfarin reversal is typically sought prior to surgery for geriatric hip fractures; however, patients often proceed to surgery with partial warfarin reversal. The effect of partial reversal (defined as having an international normalized ratio [INR] > 1.5) remains unclear. Read More

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Point-of-care testing for emergency assessment of coagulation in patients treated with direct oral anticoagulants including edoxaban.

Neurol Res Pract 2021 Mar 1;3(1). Epub 2021 Mar 1.

Department of Neurology & Stroke, University Hospital, Eberhard-Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.

Background: Direct oral anticoagulants (DOAC) including edoxaban are increasingly used for stroke prevention in atrial fibrillation. Despite treatment, annual stroke rate in these patients remains 1-2%. Rapid assessment of coagulation would be useful to guide thrombolysis or reversal therapy in this growing population of DOAC/edoxaban-treated stroke patients. Read More

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Direct Oral Anticoagulants Plasma Levels Measurement: Clinical Usefulness from Trials and Real-World Data.

Semin Thromb Hemost 2021 Mar 26;47(2):150-160. Epub 2021 Feb 26.

Division of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" Monaldi Hospital, Naples, Italy.

Measurement of direct oral anticoagulants (DOACs) activity is not routinely necessary. Indeed, evaluation of DOACs plasmatic concentration is discouraged for the majority of patients, due to the lack of outcome data supporting this approach. Nevertheless, DOAC measurements may be useful in emergency situations such as serious bleeding events, need for urgent invasive procedures, and acute ischemic stroke or in managing anticoagulation in "special populations" not adequately studied in clinical trials, for example the very elderly or those at the extremes of body weight. Read More

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Effect of Enzyme-Inducing Antiseizure Medications on the Risk of Sub-Therapeutic Concentrations of Direct Oral Anticoagulants: A Retrospective Cohort Study.

CNS Drugs 2021 03 17;35(3):305-316. Epub 2021 Feb 17.

Department of Medicine, Hadassah Hebrew University Medical Center, Mount Scopus, 91540, Jerusalem, Israel.

Background: Stroke and thromboembolic events occurring among patients taking direct oral anticoagulants (DOACs) have been associated with low concentrations of DOACs. Enzyme-inducing antiseizure medications (EI-ASMs) are associated with enhanced cytochrome-P450-mediated metabolism and enhanced P-glycoprotein-mediated transport.

Objective: The aim of this study was to evaluate the effect of concomitant EI-ASM use on DOAC peak concentrations in patients treated in clinical care. Read More

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Direct oral anticoagulants in point-of-care monitoring: an ex-vivo study.

Minerva Anestesiol 2021 05 16;87(5):514-522. Epub 2021 Feb 16.

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Frankfurt, Frankfurt am Main, Germany.

Background: Anticoagulatory activity of direct oral anticoagulants (DOACs) is not routinely measurable by point-of-care monitoring. Thus, the aim of this study was to evaluate the influence of dabigatran/rivaroxaban on point-of-care testing.

Methods: Samples from 34 participants under DOAC therapy were drawn at two time points. Read More

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Direct Oral Anticoagulants in Atrial Fibrillation: Practical Considerations and Remaining Issues.

Hamostaseologie 2021 Feb 15;41(1):35-41. Epub 2021 Feb 15.

Thrombosis Research Unit, Department of Medicine I, Division Hematology, University Hospital "Carl Gustav Carus" Dresden, Dresden, Germany.

Preventing thromboembolic events, while minimizing bleeding risks, remains challenging when managing patients with atrial fibrillation. Despite large and successful trial programs, several clinical concerns remain which commonly relate to fears of over- or underexposure to drugs and unfavorable outcomes. After a short summary of the main phase III trial findings, this short review discusses the evidence and clinical relevance of common clinical concerns (correct direct oral anticoagulant [DOAC] dosing; DOAC in moderate-to-severe renal impairment; and the relevance of fasting, nasogastric tube feeding, or high body mass index) on DOAC plasma levels. Read More

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February 2021