Does the Russell Viper Venom time test provide a rapid estimation of the intensity of oral anticoagulation? A cohort study. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Douxfils, Jonathan; Chatelain, Bernard; Hjemdahl, Paul; Devalet, Bérangère; Sennesael, Anne-Laure; Wallemacq, Pierre; Rönquist-Nii, Yuko; Pohanka, Anton; Dogné, Jean-Michel; Mullier, François
• Is Part Of: Thrombosis research. Volume 135:Issue 5(2015)
• Page Start: 852
• Page End: 860
• Publication Date: 2015-05
• Subjects: Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2015.02.020
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: Dilute Russell Viper Venom Time (DRVV-T) might be useful in urgent settings for screening patients on Non-VKA Oral Anticoagulants (NOACs). Aim: To compare the accuracy of DRVV-T with gold standard assays for the assessment of pharmacodynamics of dabigatran, rivaroxaban and vitamin K antagonist (VKA) in plasma samples from patients. Methods: Sixty rivaroxaban, 48 dabigatran and 50 VKA samples from patients were included. DRVV-T was performed in all groups using STA®-Staclot®DRVV-Screen and -Confirm. For NOACs, PT and aPTT were performed using different reagents while plasma drug concentrations were measured by liquid mass-spectrometry (LC-MS/MS). For VKA, INR was performed using RecombiPlasTin 2G®. Results: For NOACs, correlations between calibrated STA®-Staclot®DRVV-Confirm and LC-MS/MS (rs = 0.88 and 0.97 for rivaroxaban and dabigatran, respectively) were higher than the ones obtained with STA®-Staclot®DRVV-Screen (rs = 0.87 and 0.91), PT (rs = 0.83 to 0.86) or aPTT (rs = 0.84 to 0.89). Bland Altman analyses showed that calibrated DRVV-T methods tend to overestimate plasma concentrations of NOACs. ROC curves revealed that cut-off to exclude supra-therapeutic levels at Ctrough (i.e. 200 ng/mL) are different for dabigatran and rivaroxaban. Neither STA®-Staclot®DRVV-Screen nor –Confirm correlated sufficiently with the intensity of VKA therapy (rs = 0.35 and 0.52). Conclusions: STA®-Staclot®DRVV-Confirm provides a rapid estimation of the intensity of anticoagulation with rivaroxaban or dabigatran without specific calibrators. At Ctrough, thresholds for rivaroxaban and dabigatran can be used to identify supra-therapeutic plasma level. However, this test cannot differentiate the nature of the NOACs. The development of a point-of-care device optimising this method would be of particular interest in emergency situations. Highlights: DRVV-Confirm may provide information on the intensity of anticoagulation with NOACs DRVV-Confirm is more informative than PT and aPTT to identify supra-therapeutic levels of NOACs DRVV-Confirm should not be used for the accurate estimation of plasma NOACs concentrations These results can serve as hypotheses to develop a point-of-care device