title: PT, aPTT, TT and the hemostatic safety threshold of dabigatran and rivaroxaban.
abstract: The proposals of the Working group on perioperative hemostasis (Groupe d'intérêt en hémostase péri-opératoire (GIHP)) concerning the perioperative management of patients receiving the direct oral anticoagulants (DOACs) are based on the measure of their anticoagulant activities (anti-Xa for rivaroxaban and anti-IIa for dabigatran) with a safety threshold ≤ 30 ng/mL. If the dosage of the drug is not available, proposals are based on the combination of a PT ≥80% and an aPTT ≤1.20. The aim of our study was to evaluate the performance of PT, aPTT and thrombin time to predict values above or below the safety threshold. The measurement of DOACs concentration was carried out in 64 samples from patients treated with rivaroxaban and 48 samples from patients treated with dabigatran. The PT and aPTT were measured for all samples, while the TT was measured only for patients receiving dabigatran. The absence of agreement between the global hemostasis tests and the DOACs concentrations was observed for 10% of patients receiving dabigatran and 27% of patients with rivaroxaban treatment. Apart from dabigatran for which the predictive negative value of PT and aPTT or TT allows to exclude a concentration >30 ng/mL in 100% of cases, our results highlight the risk of misinterpretation when using global coagulation tests (PT and aPPT) for determination of the safety threshold for patients receiving the DOACs.
authors: Laboratoire d'hématologie, Hôpitaux universitaires Paris Centre Cochin-Broca-Hôtel Dieu (AP-HP), Paris, France.
authors: Firas
authors: F
authors: Ibrahim
authors: Laboratoire d'hématologie, Hôpitaux universitaires Paris Centre Cochin-Broca-Hôtel Dieu (AP-HP), Paris, France, Inserm UMR-S-1140, Université Paris-Descartes, Paris, France.
authors: Leyla
authors: L
authors: Calmette
authors: Laboratoire d'hématologie, Hôpitaux universitaires Paris Centre Cochin-Broca-Hôtel Dieu (AP-HP), Paris, France.
authors: Ayham
authors: A
authors: Layka
authors: Laboratoire d'hématologie, Hôpitaux universitaires Paris Centre Cochin-Broca-Hôtel Dieu (AP-HP), Paris, France, Inserm UMR-S-1140, Université Paris-Descartes, Paris, France.
authors: Marie-Hélène
authors: MH
authors: Horellou
authors: Laboratoire d'hématologie, Hôpitaux universitaires Paris Centre Cochin-Broca-Hôtel Dieu (AP-HP), Paris, France.
authors: Élisabeth
authors: É
authors: Mazoyer
authors: Laboratoire d'hématologie, Hôpitaux universitaires Paris Centre Cochin-Broca-Hôtel Dieu (AP-HP), Paris, France, Inserm UMR-S-1140, Université Paris-Descartes, Paris, France.
authors: Isabelle
authors: I
authors: Gouin-Thibault
authors: Laboratoire d'hématologie, Hôpitaux universitaires Paris Centre Cochin-Broca-Hôtel Dieu (AP-HP), Paris, France.
authors: Claire
authors: C
authors: Flaujac
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D000991:Antithrombins / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D001774:Blood Chemical Analysis; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests / Q000379:methods; D000069604:Dabigatran / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D010314:Partial Thromboplastin Time / Q000379:methods; D011516:Prothrombin / Q000032:analysis*; D000069552:Rivaroxaban / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D011516:Prothrombin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: GIHP; PT; aPTT; dabigatran; rivaroxaban; safety threshold