Why the study?
Experience with rotational thromboelastometry to measure direct oral anticoagulant levels or activity during serious bleeding, urgent interventions, or thromboembolic events remains limited.
This article reviews the use of rotational thromboelastometry (ROTEM) for managing bleeding and guiding reversal strategies in patients treated with direct oral anticoagulants.
Answers are grounded in this paper and cite their sources.
No clinical data here precludes practice change; leaves open ROTEM utility in DOAC bleeding management.
Direct oral anticoagulants (DOACs) are increasingly used worldwide for the prevention of stroke in patients with atrial fibrillation and to prevent or treat venous thromboembolism. In situations such as serious bleeding, the need for urgent surgery/intervention or the management of a thromboembolic event, the laboratory measurement of DOACs levels or anticoagulant activity may be required. Rotational thromboelastometry (ROTEM) is a viscoelastic hemostatic assay (VHA) which has been used in emergencies (trauma and obstetrics), and surgical procedures (cardiac surgery and liver transplants), but experience with this assay in DOACs-treated patients is still limited. This article reviews the use of ROTEM in the setting of DOACs therapy, focusing on DOACs-associated bleeding and the use of this VHA for the management of reversal strategies for DOACs-associated anticoagulation.
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Korpallová et al. (2021) studied this question.
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