The anticoagulant effect of therapeutic levels of dabigatran in atrial fibrillation evaluated by thrombelastography (TEG®), Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT)

Sacha Solbeck; Annette Schophuus Jensen; Christian Maschmann; Jakob Stensballe; Sisse Rye Ostrowski; Pär I Johansson

doi:10.1080/00365513.2017.1408138

The anticoagulant effect of therapeutic levels of dabigatran in atrial fibrillation evaluated by thrombelastography (TEG®), Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT)

Sacha Solbeck, Annette Schophuus Jensen, Christian Maschmann, Jakob Stensballe, Sisse Rye Ostrowski, Pär I Johansson

8 Citationer (Scopus)

Abstract

Monitoring the effect of dabigatran (Pradaxa®) is challenging. The aim of this study was to evaluate if thrombelastography reaction time (TEG® R) could detect the anticoagulant effect of dabigatran showing a correlation between TEG® R, Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT) in patients with non-valvular atrial fibrillation (NVAF). Blood samples from 35 AF patients receiving either 110 mg (n 19) or 150 mg (n 16) dabigatran twice daily were analyzed with TEG®, HTI and ECT 2-3 h after dabigatran intake. All patients had prolonged TEG® R. The patients receiving dabigatran 110 mg ×2 had a TEG® R mean 14.2 min (range 9.1-25), a mean dabigatran concentration measured by HTI of 268.5 ng/mL (range 54-837 ng/mL) and by ECT of 355.7 ng/mL (range 40-1020 ng/mL). The corresponding numbers for patients receiving dabigatran 150 mg ×2 were TEG® R mean of 12.5 min (range 9.2-23.2 min), mean dabigatran concentration of 179.2 ng/mL by HTI (range 26-687 ng/mL) and by ECT 225.1 ng/mL (range 42-1020 ng/mL). The two dosage groups had comparable anticoagulation demonstrated by equally prolonged TEG® R (p = .909), HTI (p = .707) and ECT (p = .567). No difference in creatinine levels in the two dosage groups was observed (p = .204) though patients with dabigatran concentration >400 ng/mL had significantly higher creatinine levels (p = .001). Large individual variation of the anticoagulant response was observed. Some patients had TEG® R values up to three times upper normal limit with immediate risk of bleeding. Our data indicate that TEG® R reflected dabigatran levels in NVAF patients and that TEG® R correlated to HTI and ECT.

Originalsprog	Engelsk
Tidsskrift	Scandinavian Journal of Clinical & Laboratory Investigation
Vol/bind	78
Udgave nummer	1-2
Sider (fra-til)	25-30
ISSN	0036-5513
DOI	https://doi.org/10.1080/00365513.2017.1408138
Status	Udgivet - 17 feb. 2018

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10.1080/00365513.2017.1408138

Citationsformater

Solbeck, S., Jensen, A. S., Maschmann, C., Stensballe, J., Ostrowski, S. R., & Johansson, P. I. (2018). The anticoagulant effect of therapeutic levels of dabigatran in atrial fibrillation evaluated by thrombelastography (TEG®), Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT). Scandinavian Journal of Clinical & Laboratory Investigation, 78(1-2), 25-30. https://doi.org/10.1080/00365513.2017.1408138

The anticoagulant effect of therapeutic levels of dabigatran in atrial fibrillation evaluated by thrombelastography (TEG®), Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT). / Solbeck, Sacha; Jensen, Annette Schophuus; Maschmann, Christian et al.

I: Scandinavian Journal of Clinical & Laboratory Investigation, Bind 78, Nr. 1-2, 17.02.2018, s. 25-30.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Solbeck, S, Jensen, AS, Maschmann, C, Stensballe, J, Ostrowski, SR & Johansson, PI 2018, 'The anticoagulant effect of therapeutic levels of dabigatran in atrial fibrillation evaluated by thrombelastography (TEG®), Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT)', Scandinavian Journal of Clinical & Laboratory Investigation, bind 78, nr. 1-2, s. 25-30. https://doi.org/10.1080/00365513.2017.1408138

Solbeck S, Jensen AS, Maschmann C, Stensballe J, Ostrowski SR, Johansson PI. The anticoagulant effect of therapeutic levels of dabigatran in atrial fibrillation evaluated by thrombelastography (TEG®), Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT). Scandinavian Journal of Clinical & Laboratory Investigation. 2018 feb. 17;78(1-2):25-30. doi: 10.1080/00365513.2017.1408138

Solbeck, Sacha ; Jensen, Annette Schophuus ; Maschmann, Christian et al. / The anticoagulant effect of therapeutic levels of dabigatran in atrial fibrillation evaluated by thrombelastography (TEG®), Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT). I: Scandinavian Journal of Clinical & Laboratory Investigation. 2018 ; Bind 78, Nr. 1-2. s. 25-30.

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title = "The anticoagulant effect of therapeutic levels of dabigatran in atrial fibrillation evaluated by thrombelastography (TEG{\textregistered}), Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT)",

abstract = "Monitoring the effect of dabigatran (Pradaxa{\textregistered}) is challenging. The aim of this study was to evaluate if thrombelastography reaction time (TEG{\textregistered} R) could detect the anticoagulant effect of dabigatran showing a correlation between TEG{\textregistered} R, Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT) in patients with non-valvular atrial fibrillation (NVAF). Blood samples from 35 AF patients receiving either 110 mg (n 19) or 150 mg (n 16) dabigatran twice daily were analyzed with TEG{\textregistered}, HTI and ECT 2-3 h after dabigatran intake. All patients had prolonged TEG{\textregistered} R. The patients receiving dabigatran 110 mg ×2 had a TEG{\textregistered} R mean 14.2 min (range 9.1-25), a mean dabigatran concentration measured by HTI of 268.5 ng/mL (range 54-837 ng/mL) and by ECT of 355.7 ng/mL (range 40-1020 ng/mL). The corresponding numbers for patients receiving dabigatran 150 mg ×2 were TEG{\textregistered} R mean of 12.5 min (range 9.2-23.2 min), mean dabigatran concentration of 179.2 ng/mL by HTI (range 26-687 ng/mL) and by ECT 225.1 ng/mL (range 42-1020 ng/mL). The two dosage groups had comparable anticoagulation demonstrated by equally prolonged TEG{\textregistered} R (p = .909), HTI (p = .707) and ECT (p = .567). No difference in creatinine levels in the two dosage groups was observed (p = .204) though patients with dabigatran concentration >400 ng/mL had significantly higher creatinine levels (p = .001). Large individual variation of the anticoagulant response was observed. Some patients had TEG{\textregistered} R values up to three times upper normal limit with immediate risk of bleeding. Our data indicate that TEG{\textregistered} R reflected dabigatran levels in NVAF patients and that TEG{\textregistered} R correlated to HTI and ECT.",

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author = "Sacha Solbeck and Jensen, {Annette Schophuus} and Christian Maschmann and Jakob Stensballe and Ostrowski, {Sisse Rye} and Johansson, {P{\"a}r I}",

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T1 - The anticoagulant effect of therapeutic levels of dabigatran in atrial fibrillation evaluated by thrombelastography (TEG®), Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT)

AU - Solbeck, Sacha

AU - Jensen, Annette Schophuus

AU - Maschmann, Christian

AU - Stensballe, Jakob

AU - Ostrowski, Sisse Rye

AU - Johansson, Pär I

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N2 - Monitoring the effect of dabigatran (Pradaxa®) is challenging. The aim of this study was to evaluate if thrombelastography reaction time (TEG® R) could detect the anticoagulant effect of dabigatran showing a correlation between TEG® R, Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT) in patients with non-valvular atrial fibrillation (NVAF). Blood samples from 35 AF patients receiving either 110 mg (n 19) or 150 mg (n 16) dabigatran twice daily were analyzed with TEG®, HTI and ECT 2-3 h after dabigatran intake. All patients had prolonged TEG® R. The patients receiving dabigatran 110 mg ×2 had a TEG® R mean 14.2 min (range 9.1-25), a mean dabigatran concentration measured by HTI of 268.5 ng/mL (range 54-837 ng/mL) and by ECT of 355.7 ng/mL (range 40-1020 ng/mL). The corresponding numbers for patients receiving dabigatran 150 mg ×2 were TEG® R mean of 12.5 min (range 9.2-23.2 min), mean dabigatran concentration of 179.2 ng/mL by HTI (range 26-687 ng/mL) and by ECT 225.1 ng/mL (range 42-1020 ng/mL). The two dosage groups had comparable anticoagulation demonstrated by equally prolonged TEG® R (p = .909), HTI (p = .707) and ECT (p = .567). No difference in creatinine levels in the two dosage groups was observed (p = .204) though patients with dabigatran concentration >400 ng/mL had significantly higher creatinine levels (p = .001). Large individual variation of the anticoagulant response was observed. Some patients had TEG® R values up to three times upper normal limit with immediate risk of bleeding. Our data indicate that TEG® R reflected dabigatran levels in NVAF patients and that TEG® R correlated to HTI and ECT.

AB - Monitoring the effect of dabigatran (Pradaxa®) is challenging. The aim of this study was to evaluate if thrombelastography reaction time (TEG® R) could detect the anticoagulant effect of dabigatran showing a correlation between TEG® R, Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT) in patients with non-valvular atrial fibrillation (NVAF). Blood samples from 35 AF patients receiving either 110 mg (n 19) or 150 mg (n 16) dabigatran twice daily were analyzed with TEG®, HTI and ECT 2-3 h after dabigatran intake. All patients had prolonged TEG® R. The patients receiving dabigatran 110 mg ×2 had a TEG® R mean 14.2 min (range 9.1-25), a mean dabigatran concentration measured by HTI of 268.5 ng/mL (range 54-837 ng/mL) and by ECT of 355.7 ng/mL (range 40-1020 ng/mL). The corresponding numbers for patients receiving dabigatran 150 mg ×2 were TEG® R mean of 12.5 min (range 9.2-23.2 min), mean dabigatran concentration of 179.2 ng/mL by HTI (range 26-687 ng/mL) and by ECT 225.1 ng/mL (range 42-1020 ng/mL). The two dosage groups had comparable anticoagulation demonstrated by equally prolonged TEG® R (p = .909), HTI (p = .707) and ECT (p = .567). No difference in creatinine levels in the two dosage groups was observed (p = .204) though patients with dabigatran concentration >400 ng/mL had significantly higher creatinine levels (p = .001). Large individual variation of the anticoagulant response was observed. Some patients had TEG® R values up to three times upper normal limit with immediate risk of bleeding. Our data indicate that TEG® R reflected dabigatran levels in NVAF patients and that TEG® R correlated to HTI and ECT.

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KW - Aged

KW - Aged, 80 and over

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KW - Antithrombins/therapeutic use

KW - Atrial Fibrillation/blood

KW - Blood Coagulation Tests

KW - Dabigatran/therapeutic use

KW - Demography

KW - Dose-Response Relationship, Drug

KW - Endopeptidases/therapeutic use

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Thrombelastography

U2 - 10.1080/00365513.2017.1408138

DO - 10.1080/00365513.2017.1408138

M3 - Journal article

C2 - 29304563

SN - 0036-5513

VL - 78

SP - 25

EP - 30

JO - Scandinavian Journal of Clinical & Laboratory Investigation

JF - Scandinavian Journal of Clinical & Laboratory Investigation

IS - 1-2

ER -

The anticoagulant effect of therapeutic levels of dabigatran in atrial fibrillation evaluated by thrombelastography (TEG®), Hemoclot Thrombin Inhibitor (HTI) assay and Ecarin Clotting Time (ECT)

Abstract

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