Advancing Point-of-Care Analysis: The Future of Thromboelastographic DOAC-Detection: A Systematic Review - PubMed
7 hours ago
- #Thromboelastography
- #DOACs
- #Point-of-Care Testing
- Direct oral anticoagulants (DOACs) have largely replaced vitamin K antagonists due to their predictable pharmacokinetics and improved safety.
- In emergency situations like urgent surgery or major bleeding, rapid assessment of DOAC activity is crucial.
- Conventional viscoelastic testing (VET) devices are insufficiently sensitive to detect DOACs, leading to the development of modified assays.
- Ecarin-based assays showed 100% sensitivity and specificity for detecting dabigatran.
- For factor Xa inhibitors (rivaroxaban, apixaban, edoxaban), modified assays using Russell's Viper Venom and low-tissue-factor activation showed variable but generally good correlations with drug levels.
- Sensitivity was lower for apixaban (83-97%) compared to rivaroxaban (90-100%) and edoxaban (100%).
- Factor Xa-based and low-tissue-factor assays achieved sensitivities of 85-100% and specificities of 62-100%.
- Modified VET assays show promise as rapid point-of-care tools for DOAC detection in emergencies.
- Further clinical validation and standardization are needed before routine implementation.