Fully automated thromboelastograph TEG 6s to measure anticoagulant effects of direct oral anticoagulants in healthy male volunteers

摘要

Background The ability to assess the hemostatic effect of the direct oral anticoagulant (DOACs) may be valuable in clinical situations such as bleeding or thrombosis, before urgent surgery, or reversal of anticoagulation. We sought to assess the anticoagulant effect of DOACs with the new‐generation fully automated thrombelastograph TEG 6s using resonance‐frequency viscoelasticity measurements and disposable multichannel microfluidic cartridges. Methods A single dose of oral dabigatran 150?mg, rivaroxaban 20?mg, or apixaban 5?mg was given to 9 healthy males. Phlebotomy was performed at 0, 1, and 3?hours after administration of DOAC. TEG parameters were measured using TEGsup_/sup6s. Concentrations of DOACs were measured using chromogenic assays. The TEG parameters were correlated to the DOAC concentrations. Results The reaction time (R) demonstrated the strongest response to DOAC intake. There were no correlations between other TEG parameters and DOAC concentrations. Using the direct thrombin inhibitor (DTI) channel, R was significantly correlated with dabigatran levels (r?=?0.94, P??0.0001). Using the anti–factor Xa (AFXa) channel, R was significantly correlated with rivaroxaban and apixaban levels (r?=?0.93 and r?=?0.83, respectively; P??0.0001 for both). R 2.5?minutes for dabigatran (DTI channel), 2.5?minutes for apixaban, and 1.8?minutes for rivaroxaban (AFXa channel) were associated with 100% sensitivity and?≥?90% specificity to detect DOAC levels of?≥?50?ng/mL. Conclusion We have demonstrated that TEGsup_/sup6s R has significant correlation with DOAC blood concentrations and has potential for monitoring the DOAC's effect on hemostasis with reasonable sensitivity in the small sample analyzed. This novel technology is easy to use on a small volume of whole blood without requiring a specialized laboratory. Further study is warranted to correlate R with clinical outcomes.