Calibration-free electrochemical sensor to monitor factor-Xa inhibitors at the point-of-care anticoagulation therapy

Mruthunjaya, Ashwin K.V.; Chatelier, Ronald C.; Torriero, Angel A.J.

doi:10.1016/j.talanta.2023.125593

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…Similarly to the case of thrombin, monitoring FXa activity is another viable method for quantifying anticoagulants. This was confirmed by our group; by using a disposable gold co-facing recycling electrode system, an FXa enzyme-based POC assay was demonstrated for DOACs involving rivaroxaban, edoxaban, and LMWHs, such as enoxaparin and dalteparin [58]. The working principle of this sensor is similar to that described in Figure 3.…”

Section: Electrochemical Sensors For Anticoagulants Using Thrombin-sp...supporting

confidence: 63%

“…In response to this dilemma, our recent investigations have considered the feasibility of substituting the drug-specific calibration requirements with a unified calibration strategy, encompassing a singular calibration curve for DOACs and another for LMWHs. This approach aims to enable the quantification of inhibitors within both the DOAC (e.g., rivaroxaban and edoxaban) and LMWH (e.g., enoxaparin and dalteparin) categories [58]. Our findings indicate that this sensor can accurately identify and measure the levels of rivaroxaban and edoxaban without the need for individual calibration curves or a universal calibration scheme, achieving an acceptable margin of error, even when the specific identity of the inhibitor is unknown, with results displaying an error margin of ±3 ng/mL.…”

Section: Common Calibration Methodsmentioning

confidence: 99%

“…WE = working electrode, CE = counter electrode, and pseudo-RE = Au pseudo-reference electrode. Adapted from references[56][57][58].…”

mentioning

confidence: 99%

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Electrochemical Monitoring in Anticoagulation Therapy

Mruthunjaya,

Torriero

2024

Molecules

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The process of blood coagulation, wherein circulating blood transforms into a clot in response to an internal or external injury, is a critical physiological mechanism. Monitoring this coagulation process is vital to ensure that blood clotting neither occurs too rapidly nor too slowly. Anticoagulants, a category of medications designed to prevent and treat blood clots, require meticulous monitoring to optimise dosage, enhance clinical outcomes, and minimise adverse effects. This review article delves into the various stages of blood coagulation, explores commonly used anticoagulants and their targets within the coagulation enzyme system, and emphasises the electrochemical methods employed in anticoagulant testing. Electrochemical sensors for anticoagulant monitoring are categorised into two types. The first type focuses on assays measuring thrombin activity via electrochemical techniques. The second type involves modified electrode surfaces that either directly measure the redox behaviours of anticoagulants or monitor the responses of standard redox probes in the presence of these drugs. This review comprehensively lists different electrode compositions and their detection and quantification limits. Additionally, it discusses the potential of employing a universal calibration plot to replace individual drug-specific calibrations. The presented insights are anticipated to significantly contribute to the sensor community’s efforts in this field.

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Section: Electrochemical Sensors For Anticoagulants Using Thrombin-sp...supporting

confidence: 63%

Section: Common Calibration Methodsmentioning

confidence: 99%

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Electrochemical Monitoring in Anticoagulation Therapy

Mruthunjaya,

Torriero

2024

Molecules

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Perioperative Management of Patients Taking Direct Oral Anticoagulants

Douketis,

Spyropoulos

2024

JAMA

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ImportanceDirect oral anticoagulants (DOACs), comprising apixaban, rivaroxaban, edoxaban, and dabigatran, are commonly used medications to treat patients with atrial fibrillation and venous thromboembolism. Decisions about how to manage DOACs in patients undergoing a surgical or nonsurgical procedure are important to decrease the risks of bleeding and thromboembolism.ObservationsFor elective surgical or nonsurgical procedures, a standardized approach to perioperative DOAC management involves classifying the risk of procedure-related bleeding as minimal (eg, minor dental or skin procedures), low to moderate (eg, cholecystectomy, inguinal hernia repair), or high risk (eg, major cancer or joint replacement procedures). For patients undergoing minimal bleeding risk procedures, DOACs may be continued, or if there is concern about excessive bleeding, DOACs may be discontinued on the day of the procedure. Patients undergoing a low to moderate bleeding risk procedure should typically discontinue DOACs 1 day before the operation and restart DOACs 1 day after. Patients undergoing a high bleeding risk procedure should stop DOACs 2 days prior to the operation and restart DOACs 2 days after. With this perioperative DOAC management strategy, rates of thromboembolism (0.2%-0.4%) and major bleeding (1%-2%) are low and delays or cancellations of surgical and nonsurgical procedures are infrequent. Patients taking DOACs who need emergent (&lt;6 hours after presentation) or urgent surgical procedures (6-24 hours after presentation) experience bleeding rates up to 23% and thromboembolism as high as 11%. Laboratory testing to measure preoperative DOAC levels may be useful to determine whether patients should receive a DOAC reversal agent (eg, prothrombin complex concentrates, idarucizumab, or andexanet-α) prior to an emergent or urgent procedure.Conclusions and RelevanceWhen patients who are taking a DOAC require an elective surgical or nonsurgical procedure, standardized management protocols can be applied that do not require testing DOAC levels or heparin bridging. When patients taking a DOAC require an emergent, urgent, or semiurgent surgical procedure, anticoagulant reversal agents may be appropriate when DOAC levels are elevated or not available.

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