Microfluidic coagulation assay for monitoring anticoagulant therapy in acute stroke patients

2017 ◽  
Vol 117 (03) ◽  
pp. 519-528 ◽  
Author(s):  
Annemarie Bluecher ◽  
Sascha Meyer dos Santos ◽  
Nerea Ferreirós ◽  
Sandra Labocha ◽  
Isabel Maria Rodrigues Meyer dos Santos ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Vitamin K ◽  
Whole Blood ◽  
Acoustic Waves ◽  
Oral Anticoagulants ◽  
Surface Acoustic Waves ◽  
Vitamin K Antagonist ◽  
Emergency Setting ◽  
Stroke Patients ◽  
Emergency Patients

SummaryReliable detection of anticoagulation status in patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) is challenging but of importance especially in the emergency setting. This study evaluated the potential of a whole-blood clotting time assay based on Surface Acoustic Waves (SAW-CT) in stroke-patients. The SAW-technology was used for quick and homogenous recalcification of whole blood inducing a surface-activated clotting reaction quantified and visualised by real-time fluorescence microscopy with automatic imaging processing. In 20 stroke or transient ischaemic attack (TIA)-patients taking NOACs kinetics of SAW-CT were assessed and correlated to other coagulation parameters (PT, aPTT) and NOAC-plasma concentration measured by tandem mass spectrometry (LC-MS/MS). In 225 emergency patients with suspicion of acute stroke or TIA, SAW-CT values were assessed. Mean (± SD) SAW-CT in non-anticoagulated stroke patients (n=180) was 124 s (± 21). In patients on dabigatran or rivaroxaban, SAW-CT values were significantly higher 2 and 8 hours (h) after intake rising up to 267 seconds (s) (dabigatran, 2 h after intake) and 250 s (rivaroxaban, 8 h after intake). In patients on apixaban, SAW-CT values were only moderately increased 2 h after intake (SAW-CT 153 s). In emergency patients, SAW-CT values were significantly higher in NOAC and vitamin K antagonist (VKA)-treated as compared to non-anticoagulated patients. In conclusion, the SAW-CT assay is capable to monitor anticoagulant level and effect in patients receiving dabigatran, rivaroxaban and the VKA phenprocoumon. It has a limited sensitivity for apixaban-detection. If specific SAW-CT results were used as cut-offs, SAW-CT yields high diagnostic accuracy to exclude relevant rivaroxaban and dabigatran concentrations in strokepatients.

Abstract 20: Specific Point-of-care Testing of Coagulation in Patients Treated with Non-vitamin K Antagonist Oral Anticoagulants Part I (SPOCT-NOAC I)

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Florian J Härtig ◽  
Andreas Peter ◽  
Charlotte Spencer ◽  
Matthias Ebner ◽  
Christine Meyer-Zuern ◽  
...  
Keyword(s):  
Vitamin K ◽  
Whole Blood ◽  
Point Of Care ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Rapid Assessment ◽  
Plasma Concentrations ◽  
Vitamin K Antagonist ◽  
Point Of Care Testing ◽  
Blood Samples

Introduction: Non-vitamin K antagonist oral anticoagulants (NOAC) are increasingly replacing vitamin K antagonists for prevention of thromboembolism in atrial fibrillation (AF). Despite treatment, stroke rate in NOAC-treated AF-patients remains 1-2% per year. Subsequently, stroke physicians face a growing number of NOAC-treated patients with acute stroke. Rapid assessment of coagulation in NOAC-treated patients is vital prior to thrombolysis or reversal therapy, but existing point-of-care testing (POCT) is suboptimal. For the first time we evaluate NOAC-specific POCT. Hypothesis: Ecarin clotting time (ECT)- and anti-Xa activity (ENOX)-POCT predict plasma concentrations of dabigatran and apixaban/edoxaban/rivaroxaban. Methods: 80 patients receiving first NOAC-dose and 80 already on NOAC-treatment are enrolled in the SPOCT-NOAC I trial (N=40 for each NOAC). Subjects receiving other anticoagulants are excluded. Six blood samples are collected from each patient: before drug intake, 30min, 1, 2, and 8h after intake, and before next dose. NOAC-concentrations are measured by mass spectrometry. Results: 240 blood samples of 40 dabigatran-treated patients were analyzed. Dabigatran-concentrations ranged from 0-274ng/mL. ECT-POCT ranged from 20-196s. Pearson’s correlation coefficient showed strong correlation between ECT-POCT and dabigatran-concentrations (r=0.87). Performance was improved through the use of citrated in place of non-citrated whole blood (r=0.93). Dabigatran-concentrations >50ng/mL (threshold for thrombolysis according to expert recommendation) were detected by ECT-POCT >50s with 98% sensitivity and 79% specificity. Baseline-samples not containing any dabigatran yielded normal ECT values. Conclusions: This is the first study evaluating NOAC-specific POCT. Final results in the dabigatran group of SPOCT-NOAC show excellent correlation between ECT-POCT and dabigatran plasma concentrations; performance of ECT-POCT is even increased through the use of citrated whole blood. Relevant dabigatran-concentrations are detected with excellent sensitivity and specificity. In addition to ECT-POCT, we will present data on ENOX-POCT from apixaban-, edoxaban- and rivaroxaban-treated patients.

scholarly journals Risk of recurrent stroke for Asian stroke patients treated with non-vitamin K antagonist oral anticoagulant and warfarin

2020 ◽  
Vol 11 ◽  
pp. 204062232097485
Author(s):  
Sheng-Feng Lin ◽  
Yi-Hsuan Lu ◽  
Chyi-Huey Bai
Keyword(s):  
Ischemic Stroke ◽  
Vitamin K ◽  
Hemorrhagic Stroke ◽  
Recurrent Stroke ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Stroke Recurrence ◽  
Research Database ◽  
Stroke Patients ◽  
Stroke Population

Aim: The aim of this study was to establish whether non-vitamin K antagonist oral anticoagulants (NOACs) are superior to warfarin in preventing stroke recurrence for atrial fibrillation (AF) patients with an ischemic or hemorrhagic stroke at the baseline. Methods: From 1 January 2009 to 31 December 2017, stroke patients with AF treated with oral anticoagulants in the National Health Insurance Research Database in Taiwan were enrolled. The study was retrospective cohort design. Outcome measures were ischemic and hemorrhagic stroke recurrence. The Cox proportional hazard model was used to obtain the hazard ratio (HR). Results: In total, 39,840 stroke patients with AF treated with NOAC and 42,583 treated with warfarin were identified. NOACs were superior to warfarin in preventing all recurrent stroke [adjusted HR: 0.67, 95% confidence interval (CI), 0.63–0.71, p < 0.001]. Results for the ischemic stroke population were the same as that for all types for stroke (adjusted HR: 0.66, 95% CI, 0.62–0.70, p < 0.001). For the hemorrhagic stroke population, NOACs were equivalent to warfarin in preventing ischemic stroke (adjusted HR: 1.11, 95% CI, 0.86–0.43, p < 0.001), but NOACs were superior to warfarin in preventing hemorrhagic stroke (adjusted HR: 0.64, 95% CI, 0.55–0.74, p < 0.001). Conclusions: NOACs were generally superior to warfarin in terms of efficacy and safety in previous stroke patients. The robustness of our findings was verified and should add new information to current recommendations for Asian stroke patients in selecting NOACs.

scholarly journals Coagulation Testing in Acute Ischemic Stroke Patients Taking Non–Vitamin K Antagonist Oral Anticoagulants

Stroke ◽  
2017 ◽  
Vol 48 (1) ◽  
pp. 152-158 ◽  
Author(s):  
Jan C. Purrucker ◽  
Kirsten Haas ◽  
Timolaos Rizos ◽  
Shujah Khan ◽  
Sven Poli ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Stroke Patients ◽  
Coagulation Testing

Non-vitamin K antagonist oral anticoagulants and sport

2020 ◽  
Vol 68 (2) ◽  
Author(s):  
Silvio Romano ◽  
Elisa Salustri ◽  
Antonio G. Robles ◽  
Leonardo Calò ◽  
Maria Penco ◽  
...  
Keyword(s):  
Vitamin K ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist
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