Background: While prothrombin complex concentrates (PCC) have been proven to be effective to reverse vitamin K antagonists (VKA), PCC is also used to reverse direct oral anticoagulants (DOACs) in a non-specific manner. We previously measured thrombin generation (TG) following the reversion of bleeding patients treated with OAC with CAT method and showed a hypercoagulable state after reversion for patients treated with DOACs (ISTH 2019 Poster PB1659).
Aims: Our study, supported by Stago, aims to evaluate the new thrombin generation system (ST-Genesia®) using leftover plasma of our study.
Methods: Plasma of patients treated with either VKA, rivaroxaban(R) or apixaban(A) were collected at the patients’ arrival (V1), 30mins(V2), 6H(V3) and 24H(V4) post-reversion. We compared with Bland-Altman plots peaks and endogenous thrombin potentials (ETP) obtained with both instruments.
Results: Hypercoagulability was detected for DOACs at V2 (mean ± SD ETP A: 2302±693.3; R: 2628±1111 nM.min) (ETP healthy controls intervals: 1017 to 1667 nM.min as 5th and 95th percentiles) and was maintained to V4 (mean ± SD ETP A: 2348±321,2; R: 2495±418,5 nM.min). No hypercoagulability was detected for VKAs after reversion (mean ± SD ETP V2: 982.0±480.5; V3: 1137±326.8; V4: 1061±365.6 nM.min). As for the peak (healthy controls intervals: 178,2 to 359,6 nM as 5th and 95th percentiles), only patients treated with rivaroxaban became hypercoagulable at V4 (mean ± SD R: 427.7± 38.78 nM).
Conclusion(s): Patients treated with VKA and reversed with PCC have regained a normal coagulation, while patients treated with DOACs and reversed with PCC had hypercoagulability, as observed with CAT. Agreements between the two methods were satisfactory for both TG parameters.
Image 1
ETP and peak measured in orally anticoagulated patients in hemorrhage following the reversion by PCC obtained with ST-Genesia® using STG-ThromboScreen TM-. Reference intervals of ETP and peak are represented in beige. Reference intervals are expressed as mean and 5th-95th percentiles.
To cite this abstract in AMA style:
Gauthier RA, Desvoilhes A, Talon L, Sinegre T, Schmidt J, Moustafa F, Teissandier D, Lebreton A. Study of the thrombin generation in anticoagulated patients with hemorrhage complications [abstract]. https://abstracts.isth.org/abstract/study-of-the-thrombin-generation-in-anticoagulated-patients-with-hemorrhage-complications/. Accessed September 27, 2023.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/study-of-the-thrombin-generation-in-anticoagulated-patients-with-hemorrhage-complications/