Dabigatran Etexilate:Clinical Laboratory Aspects
(2018) Practical manual: Oral anticoagulants — ISBN: [978-84-945945-3-3], p. 1-97, published
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- Introduction Although routine assessment of the intensity of anticoagulation is not required with direct oral anticoagulants (DOAC), several situations may require the use of coagulation testing (bleeding, recurrence of thrombosis, before surgical intervention, before thrombolysis, extreme body weights, etc.). Guideline recommendations and consensus documents on laboratory testing of DOAC are generally consistent and provide clear guidance for clinicians1-3. The French Working Group on Perioperative Haemostasis (GIHP) has recently proposed an algorithm for the management of emergency situations in which an urgent invasive procedure is required. This includes the measurement of plasma concentrations by specific assays. For dabigatran, 30 ng/mL is considered as sufficiently safe to operate in case of intervention with bleeding risk4. Therefore, if concentration is higher than 30 ng/mL, the intervention should be delayed if possible and repeated measurement obtained until the cut-off is reached. If the intervention cannot be delayed, appropriate strategies to antagonise the anticoagulant effect should be considered5.The use of specific coagulation tests may also guide the clinician in the use of the antidote to dabigatran etexilate (e.g. idarucizumab, Praxbind®,Boehringer Ingelheim). For instance, it has been proposed that if the plasma concentration of dabigatran is below 50 ng/mL in a bleeding patient, reversal agents should not be administered4. The same threshold is also proposed by the Subcommittee on Control of Anticoagulation of the SSC of the ISTH for the administration of idarucizumab in patients requiring an urgent intervention associated with a high risk of bleeding4. In these patients, measurement of the residual plasma concentration or estimation of the anticoagulant effect should always be considered, if possible.
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Mullier, F. (2018). Dabigatran Etexilate:Clinical Laboratory Aspects. In Walter Ageno, James Douketis, Stephan T.Engelter, James C.Fredenburgh, Isabelle Gouin- Thibault, Marcel Levi, François Mullier, (ed.), Practical manual: Oral anticoagulants (p. p. 1-97). https://hdl.handle.net/2078.5/93184