Anticoagulant Monitoring: Bedside and Lab Tests

Bedside POCT of PT/INR, aPTT and ACT was conducted from whole blood. ACT was measured using ACT plus (ACT+) and ACT-low range (ACT-LR) test cards that contain different reagents and cover different measurement ranges. Further samples were collected in 3.2% sodium-citrate tubes (Sarstedt, Nümbrecht, Germany), and instantly centrifuged to acquire plasma. Laboratory-based anti-Xa activity was measured using Chromogenix COAMATIC Heparin Test on an ACL TOP 700 (Instrumentation Laboratory, Kirchheim, Germany). TECHNOVIEW calibrators (Technoclone, Vienna, Austria) were used to determine apixaban and rivaroxaban concentrations with limits of quantification of 10 and 18 ng/mL. Remaining plasma aliquots were stored at –80 °C until testing of diluted thrombin time (dTT; Hemoclot assay, Hyphen BioMed, Neuville-sur-Oise, France). As the gold standard, DOAC concentrations were determined by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS) [8 (link)]. All coagulation testing was performed according to manufacturers’ instructions by thoroughly trained investigators and technicians.

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Ebner M., Birschmann I., Peter A., Spencer C., Härtig F., Kuhn J., Blumenstock G., Zuern C.S., Ziemann U, & Poli S. (2017). Point-of-care testing for emergency assessment of coagulation in patients treated with direct oral anticoagulants. Critical Care, 21, 32.

Publication 2017

3.2% sodium-citrate tubes ACL TOP 700

Anti xa Apixaban Aptt Assay Blood Gold Heparin Liquid chromatography Plasma Rivaroxaban Sodium citrate Tandem mass spectrometry Thrombin time

Corresponding Organization :

Other organizations : Hertie Institute for Clinical Brain Research, University of Tübingen, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum

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Variable analysis

independent variables

Bedside POCT of PT/INR, aPTT and ACT was conducted from whole blood
ACT was measured using ACT plus (ACT+) and ACT-low range (ACT-LR) test cards that contain different reagents and cover different measurement ranges

dependent variables

PT/INR
Anti-Xa activity
Apixaban and rivaroxaban concentrations
Diluted thrombin time (dTT)

control variables

Whole blood samples were collected in 3.2% sodium-citrate tubes (Sarstedt, Nümbrecht, Germany), and instantly centrifuged to acquire plasma
TECHNOVIEW calibrators (Technoclone, Vienna, Austria) were used to determine apixaban and rivaroxaban concentrations
All coagulation testing was performed according to manufacturers' instructions by thoroughly trained investigators and technicians

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