Evaluation of direct oral anticoagulant use on thromboelastography in an emergency department population

Jenrette, Jordan E; Schwarz, Kerry; Trujillo, Toby C.; Ray, Lance

doi:10.1016/j.ajem.2021.12.011

Cited by 6 publications

(11 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirteen studies described rivaroxaban action in whole blood with TEG (Haemonetics Corporation, Boston MA, U.S.A.) ( 20 – 22 , 25 , 26 , 31 – 33 , 35 , 37 , 42 , 43 , 46 ) ( Supplementary Table 2.2 ). Of these, four studies did not report the exact rivaroxaban concentration under which conditions the viscoelastic tests were performed ( 22 , 25 , 32 , 33 ). Four studies investigated with the new cartridge-based anti-factor-Xa [AFXa] channel of TEG 6s ( 20 – 22 , 25 ), to the best of our knowledge not yet commercially available at the time of manuscript preparation ( Table 1.2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-two studies were identified analyzing the effects if apixaban on viscoelastic testing ( 18 , 20 – 22 , 25 – 27 , 29 , 32 , 33 , 35 , 38 , 40 , 45 , 46 , 48 – 54 ) ( Supplementary Tables 2.1 – 2.3 ). The CT and R in relation to the apixaban plasma concentration are shown in Figure 4 .…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies investigated the effects of apixaban on TEG with a focus on R value, using either the TEG 6s anti-factor Xa channel [AFXa] ( 20 – 22 , 25 ), or TEG 5000 system ( 26 , 32 , 33 , 35 , 46 , 53 , 54 ) ( Supplementary Table 2.2 ). A statistically significant, dose-dependent correlation of reaction time (R) and apixaban plasma concentration was shown with the anti-factor Xa channel [very strong correlation ( 20 , 21 )] and kaolin-TEG [moderate correlation ( 35 )] ( Tables 1.2 , 2.2 ).…”

Section: Resultsmentioning

confidence: 99%

“…The study of Kaaber et al mentions that approximately 65% of the patients treated with rivaroxaban presented with RapidTEG TM activated clotting time within the normal reference, but that those with an activated clotting time above this level had a significantly increased risk of severe bleeding with high transfusion demands (33). Three studies did not find any significant effect of rivaroxaban on TEG 5000 parameters (31,32,42). One study compared the results descriptively only (46) (Table 2…”

Section: )mentioning

confidence: 99%

See 3 more Smart Citations

The impact of direct oral anticoagulants on viscoelastic testing – A systematic review

Sahli

Castellucci

Roche

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundIn case of bleeding patients and in acute care, the assessment of residual direct oral anticoagulant (DOAC) activity is essential for evaluating the potential impact on hemostasis, especially when a timely decision on urgent surgery or intervention is required. Viscoelastic tests are crucial in a modern goal-directed coagulation management to assess patients’ coagulation status. However, the role of viscoelastic test to detect and quantify residual DOAC plasma levels is controversially discussed. The aim of this review was to systematically summarize the evidence of viscoelastic tests for the assessment of residual DOAC activity.MethodPubMed, Embase, Scopus, and the Cochrane Library were searched for original articles investigating the effect of rivaroxaban, apixaban, edoxaban, or dabigatran plasma levels on different viscoelastic tests of the adult population from database inception to December 31, 2021.ResultsWe included 53 studies from which 31 assessed rivaroxaban, 22 apixaban, six edoxaban, and 29 dabigatran. The performance of viscoelastic tests varied across DOACs and assays. DOAC specific assays are more sensitive than unspecific assays. The plasma concentration of rivaroxaban and dabigatran correlates strongly with the ROTEM EXTEM, ClotPro RVV-test or ECA-test clotting time (CT) and TEG 6s anti-factor Xa (AFXa) or direct thrombin inhibitor (DTI) channel reaction time (R). Results of clotting time (CT) and reaction time (R) within the normal range do not reliable exclude relevant residual DOAC plasma levels limiting the clinical utility of viscoelastic assays in this context.ConclusionViscoelastic test assays can provide fast and essential point-of-care information regarding DOAC activity, especially DOAC specific assays. The identification and quantification of residual DOAC plasma concentration with DOAC unspecific viscoelastic assays are not sensitive enough, compared to recommended anti-Xa activity laboratory measurements.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=320629], identifier [CRD42022320629].

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: )mentioning

confidence: 99%

See 2 more Smart Citations

The impact of direct oral anticoagulants on viscoelastic testing – A systematic review

Sahli

Castellucci

Roche

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…The ability of most widely used VHAs (thromboelastography and rotational thromboelastometry) to accurately predict coagulation status in patients on direct oral anticoagulants within the clinical setting is not uniformly reliable. 5 , 6 , 7 This point is important especially with the implementation of either more costly or potentially higher-risk thrombogenic reversal strategies, including coagulation factor Xa (recombinant), inactivated-zhzo (Andexanet Alfa), human fibrinogen concentrate, or prothrombin complex concentrate.…”

mentioning

confidence: 99%

In Reply to the Letter to the Editor Regarding “Viscoelastic Hemostatic Assays and Outcomes in Traumatic Brain Injury: A Systematic Literature Review”

Shammassian

Kelly

2022

World Neurosurgery

View full text Add to dashboard Cite

The clot thickens: How to use viscoelastic testing in critical illness

Rech

Gilbert

Nei

et al. 2023

J Am Coll Clin Pharm

View full text Add to dashboard Cite

Coagulopathy is common in critically ill patients and may result in complications such as bleeding or thromboembolic events. Viscoelastic testing (VET), including both thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®), offers a benefit over conventional coagulation tests in that it provides a qualitative and quantitative assessment of the degree of coagulopathy, including the ability to measure fibrinolysis. This review is a “how‐to” primer for critical care pharmacists to interpret and utilize VET in practice across a spectrum of coagulopathies, including trauma and traumatic brain injury, neurologic injury and emergencies, cardiothoracic surgery, liver disease, and medication‐induced coagulopathy.

show abstract

Evaluation of direct oral anticoagulant use on thromboelastography in an emergency department population

Cited by 6 publications

References 20 publications

The impact of direct oral anticoagulants on viscoelastic testing – A systematic review

The impact of direct oral anticoagulants on viscoelastic testing – A systematic review

In Reply to the Letter to the Editor Regarding “Viscoelastic Hemostatic Assays and Outcomes in Traumatic Brain Injury: A Systematic Literature Review”

The clot thickens: How to use viscoelastic testing in critical illness

Contact Info

Product

Resources

About