Does the Russell Viper Venom time test provide a rapid estimation of the intensity of oral anticoagulation? A cohort study
(2015) Thrombosis Research : vascular obstruction, hemorrhage and hemostasis — Vol. 135, n° 5, p. 852-860 (2015)
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- 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 C<inf>trough</inf> (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 C<inf>trough</inf>, 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. © 2015 Elsevier Ltd. All rights reserved.
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Douxfils, J., Chatelain, B., Hjemdahl, P., Devalet, B., Sennesael, A.-L., Wallemacq, P., Rönquist-Nii, Y., Pohanka, A., Dogné, J.-M., & Mullier, F. (2015). Does the Russell Viper Venom time test provide a rapid estimation of the intensity of oral anticoagulation? A cohort study. Thrombosis Research : vascular obstruction, hemorrhage and hemostasis, 135(5), 852-860. https://doi.org/10.1016/j.thromres.2015.02.020 (Original work published 2015)