All tested PT reagents correlated with DOAC concentrations, but reactivity varied considerably between DOACs and PT tests, and Triniclot PT Excel S showed reprolongation with higher doses of PCC.
Does the choice of prothrombin time (PT) test affect the assessment of DOAC anticoagulant activity and reversal effects?
Different prothrombin time reagents exhibit varying sensitivities to DOACs and their reversal agents, highlighting the need for specific test selection in emergency settings.
INTRODUCTION: The prompt assessment and the reversal of direct oral anticoagulants (DOACs) are urgent matters in the emergency care setting. Thus, we planned to elucidate the adequate prothrombin time (PT) test for the evaluation of the anticoagulant effects of various DOACs. METHODS: The anticoagulant effects of rivaroxaban, apixaban, and edoxaban were measured with 3 PT tests (Triniclot PT Excel S, Neoplastin R, and Thromborel S). Human plasma was spiked with each DOAC at a range of 0 to 1000 ng/mL, and the PT was measured using each PT test. In another series, the reversal effect of either 4-factor prothrombin complex concentrate (PCC) or activated PCC (aPCC) was evaluated with each PT test. RESULTS: All PT reagents correlated with the concentrations of each DOAC, however, the reactivity was considerably different between the DOACs and the PT tests. A prolonged PT with DOACs was reversed both by PCC and aPCC in a dose-dependent manner; however, Triniclot PT Excel S showed reprolongation of the PT with a higher dose of PCC. CONCLUSION: The proper choice of PT test is necessary for the assessments of the anticoagulant activity of DOACs. It is also important to understand the different characteristics of each PT test for the assessment of the reversal effects of PCC.
Nagakari et al. (2016) studied Anticoagulant effects of direct oral anticoagulants (DOACs). DOACs (rivaroxaban, apixaban, edoxaban) and reversal agents (PCC, aPCC) was evaluated on Prothrombin time (PT) correlation with DOAC concentrations and reversal effects. All tested PT reagents correlated with DOAC concentrations, but reactivity varied considerably between DOACs and PT tests, and Triniclot PT Excel S showed reprolongation with higher doses of PCC.