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Thrombin Generation Test is superior to conventional tests to monitor direct oral anticoagulants
Session:
Painel 12 -Cardio-Oncologia / Farmacologia 1
Speaker:
Cátia Santos Ferreira
Congress:
CPC 2020
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Posters
FP Number:
---
Authors:
Cátia Santos Ferreira; Francisco Marques; Margarida Castro; Ana Correia; Isabel Rasteiro; André Azul Freitas; João André Ferreira; Rui Baptista; João Pego; Helena Pinho; Inês Rocha; Manuela Alves; Lino Gonçalves
Abstract
<p>BACKGROUND: The use of direct oral anticoagulants (DOAC) is increasing, mainly to limited monitoring requirements. The test of choice for the assessment of the anticoagulant effect is the dilute thrombin time (dTT) for dabigatran and the anti-factor Xa assay for rivaroxaban, apixaban and edoxaban. However, both tests do not truly represent the achieved anticoagulation, because they measure the inhibitory activity exerted against an individual factor. The Thrombin Generation Test (TGT) is a promising tool, as it evaluates thrombin generation (procoagulant driver) and inhibition (anticoagulant driver). We aimed to assess the anticoagulant effect of the DOAC on each individual TGT parameter to assess suitability of these parameters for monitoring the global anticoagulant effect. <br /> METHODS: We prospectively included 20 senior patients on DOAC for atrial fibrillation. TGT parameters were measured at through (lag time, endogenous thrombin potential (ETP), peak height, time to peak, and velocity index). TGT parameters and DOAC concentrations were correlated. The patients were followed up for 9 months. <br /> RESULTS: The mean age was 76±7 years; 40% were male. All patients were polymedicated. The majority of the patients were under apixaban (n=12, 60%), while 4 patients were on edoxaban, 2 on rivaroxaban and 2 on dabigatran. All patients were on clinically appropriate DOAC dosages. Although all the TGT parameters were significantly correlated with DOAC activity (figure 1), peak height showed the best correlation (r=-0.74, p<0.001). Conversely, ETP was weakly correlated with DOAC levels (r=-0.65, p=0.002). Patients treated with dose reduction scheme (n=7, 35%) had a similar DOAC activity compared to patients treated with a regular dose. Additionally, no differences were found in the different TGT parameters. At the 9-month follow-up, 1 patient suffered an ischemic stroke; no major hemorrhagic events were observed. In that dabigatran-treated patient who suffered the stroke, although the dTT was in the appropriate range, the very sensitive parameters of the TGT suggested a hypercoagulability state, characterized by higher levels of ETP and peak high (table 1).</p> <p>CONCLUSION: Our preliminary analysis results indicate a potential role for TGT in improving the assessment of the thrombotic risk in patients on DOAC. The dose needed to prevent thrombosis, but still prevent bleeding, may vary in each patient. Therefore, tailoring drug dosages may be crucial in specific subgroups.</p>
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