Prothrombin Time Tests for the Monitoring of Direct Oral Anticoagulants and Their Evaluation as Indicators of the Reversal Effect

Nagakari, Kunihiko; Emmi, Mari; Iba, Toshiaki

doi:10.1177/1076029616638506

Cited by 13 publications

(14 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In volunteers treated with apixaban, APCC induced normalization of thrombin generation indices and partial correction of the PT and APTT. 69, 70 As with PCC, data on use of APCC in the management of DOAC-treated bleeding patients is lacking. Hemophilia patients treated with APCC have a thrombotic rate of 4.05 per 10 5 infusions, 75 but thrombotic risk has not been assessed in subjects on DOAC therapy.…”

Section: 0 Anti-xa Agentsmentioning

confidence: 99%

Measurement and reversal of the direct oral anticoagulants

2017

View full text Add to dashboard Cite

Direct oral anticoagulants (DOACs) offer non-inferior efficacy and improved safety compared to vitamin K antagonists (VKAs) for prevention and treatment of venous thromboembolism and prevention of stroke and systemic embolism in non-valvular atrial fibrillation. Unlike VKAs, DOACs do not require routine laboratory monitoring of anticoagulant effect and dose adjustment. In certain situations, however, laboratory assessment of anticoagulant effect may be desirable. Here we review the utility of currently available assays for assessment of DOAC effect and recommend an optimal assessment strategy for each drug, including calibrated dilute thrombin time or ecarin-based assays for dabigatran and calibrated anti-Xa activity assays for the factor Xa inhibitors. We also discuss reversal strategies, both specific and non-specific, for each drug, including the preferential use of idarucizumab for reversal of dabigatran and two agents, andexanet and ciraparantag, currently under development for reversal of rivaroxaban, apixaban and edoxaban.

show abstract

Section: 0 Anti-xa Agentsmentioning

confidence: 99%

Measurement and reversal of the direct oral anticoagulants

2017

View full text Add to dashboard Cite

show abstract

“…The potential role for PCCs in treating DOAC-associated bleeding has also been evaluated in studies using blood samples from patients and healthy volunteers (Additional file 3) [21, 39–56]. PCCs reversed some of the effects of DOACs on laboratory assays, including in two studies which utilised TEG and/or ROTEM to assess the impact of dabigatran/apixaban [41, 54].…”

Section: Overview Of Recent Data (2013–2017)mentioning

confidence: 99%

The impact of prothrombin complex concentrates when treating DOAC-associated bleeding: a review

2018

View full text Add to dashboard Cite

BackgroundBleeding complications are a risk associated with all anticoagulants. Currently, the treatment options for the management of direct oral anticoagulant (DOAC)-associated bleeding are limited. Prothrombin complex concentrates (PCCs) have been proposed as a potential therapeutic option, and evidence regarding their use is increasing.ReviewMany studies supporting PCC have used preclinical models and healthy volunteers; however, more recently, observational studies have further improved insight into current DOAC reversal strategies. Multiple clinical practice guidelines now specifically suggest use of PCCs for this indication. Specific reversal agents for Factor Xa inhibitors may become available in the near future, but data on their efficacy are still emerging.ConclusionsUltimately, a multimodal approach may be the optimal strategy to restore haemostasis in patients presenting with DOAC-associated coagulopathy.Electronic supplementary materialThe online version of this article (10.1186/s12245-018-0215-6) contains supplementary material, which is available to authorized users.

show abstract

“…PT is usually used in combination with APTT to measure the extrinsic and intrinsic pathways of coagulation [29]. PT is not only an important indicator to check the function of extrinsic coagulation system, but also an important monitoring indicator for clinical anticoagulation therapy [30]. APTT is the most commonly used sensitive screening test to reflect the coagulation activity of intrinsic coagulation system in clinic [28].…”

Section: Postoperative Aptt (Seconds)mentioning

confidence: 99%

Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity Spine Surgery: A Meta-Analysis

Xiong

Liu

et al. 2020

BioMed Research International

View full text Add to dashboard Cite

Objective. Tranexamic acid (TXA), an antifibrinolytic agent, interferes with fibrinolysis and has been used for many years to reduce blood loss during spine surgery. The purpose of our meta-analysis was to compare the effect of intravenous versus topical administration of TXA in patients undergoing nondeformity spine surgery. Methods. We searched multiple databases, including PubMed, Embase, the Cochrane library, CNKI, WanFang database, and VIP to find studies that met the inclusion criteria. A meta-analysis was performed according to the guidelines of the Cochrane Reviewer’s Handbook. Results. Eight randomized controlled trials (RCTs) were identified, including 660 patients. The surgical methods used in the included studies were nondeformity spine surgery. No significant differences were found in the two groups regarding total blood loss, intraoperative blood loss, hidden blood loss, hematocrit, hemoglobin, fibrinogen, postoperative prothrombin time (PT), postoperative activated partial thromboplastin time (APTT), drainage volume, and blood transfusion rate. There were statistically significant differences in the two groups in terms of preoperative PT (MD = −0.39, 95% CI: [−0.63, −0.15], P=0.002) and preoperative APTT (MD = 1.12, 95% CI: [0.57, 1.68], P<0.0001). Conclusion. During nondeformity spine surgery, intravenous administration of TXA did not have a significant effect on the decrease of blood loss and blood transfusion rate compared with the topical group. According to the pooled analysis of PT and APTT, intravenous and topical application of TXA may have different effects on the coagulation pathway. More high-quality RCTs are needed to explore the optimal dosage, method, timing in the future in order to recommend TXA widespread use in spine surgery.

show abstract

Prothrombin Time Tests for the Monitoring of Direct Oral Anticoagulants and Their Evaluation as Indicators of the Reversal Effect

Cited by 13 publications

References 30 publications

Measurement and reversal of the direct oral anticoagulants

Measurement and reversal of the direct oral anticoagulants

The impact of prothrombin complex concentrates when treating DOAC-associated bleeding: a review

Comparison of Intravenous versus Topical Tranexamic Acid in Nondeformity Spine Surgery: A Meta-Analysis

Contact Info

Product

Resources

About