Abstract Number: PB0579
Meeting: ISTH 2020 Congress
Background: Point-of-care tests to measure the anticoagulant effect of direct oral anticoagulants (DOAs) might be useful in emergency situations such as bleedings (when quick assessment and treatment are required).
Aims: To assess the effects of DOAs on global thromboelastometry (ROTEM) in patients hospitalized for bleeding.
Methods: Coagulation parameters were assessed at baseline, at 24 and at 72 hours in patients receiving apixaban, dabigatran or rivaroxaban, and hospitalized for an acute bleeding, and compared to those of healthy volunteers (controls). Citrated blood samples were tested by ROTEM using diluted EXTEM assay, with and without the addition of an anti-FXa catcher, and using ECATEM-B, with and without the addition of an anti-FIIa catcher.
Results: Overall, 10 patients hospitalized for major (8) or clinically-relevant-non-major (2) bleeding and 15 controls were included. Mean age of patients was 83±5 years (range 76-93), males were 70%. Three patients had intracranial hemorrhage (ICH) (post-traumatic in one), 5 had major gastrointestinal (GI) bleeding, 1 had clinically-relevant-non-major GI and 1 had muscular bleeding. DOAs were withdrawn in all patients, red blood cell transfusion administered in 5 and reversal agents used in those with ICH.
Mean clotting time (CT), CT/CT+catcher (CTc) and clot formation time CFT/CFT+catcher (CFTc) values of patients at admission were significantly higher than those of controls (p=0.01, p< 0.001 and p=0.04, respectively), patients at 72 hours (p=0.02, p=0.03 and p=0.01, respectively) and patients after reversal (p=0.01, p=0.02 and p=0.02, respectively).
Compared to controls, the CT was still significantly longer at 72 hours (p=0.04), while no significant differences were found for CT/CTc and CFT/CFTc at 74 hours and for any of the three parameters after reversal.
Conclusions: The use of ad-hoc designed reagents and catcher molecules at ROTEM was able to identify DOAs activity and the effect of reversal agents in patients with acute bleeding.
To cite this abstract in AMA style:Vedovati MC, Mosconi MG, Isidori F, Agnelli G, Becattini C. Global Thromboelastometry in Patients with Acute Bleedings on Direct Oral Anticoagulant (DOA) Treatment: The RO-DOA Bleed Study [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/global-thromboelastometry-in-patients-with-acute-bleedings-on-direct-oral-anticoagulant-doa-treatment-the-ro-doa-bleed-study/. Accessed December 3, 2021.
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