The anticoagulant effect of dabigatran is reflected in the lag time and time-to-peak, but not in the endogenous thrombin potential or peak, of thrombin generation

Saartje Bloemen, Suzanne Zwaveling, Jonathan Douxfils, Mark Roest, Romy Kremers, François Mullier

Research output: Contribution to journalArticlepeer-review

Abstract

INTRODUCTION: Calibrated automated thrombinography (CAT) is a sensitive method to assess coagulation. Dabigatran inhibits both free thrombin and the α2macroglobulin (α2M)-thrombin complex, which results in an erroneously increased peak and endogenous thrombin potential (ETP) without affecting lag time and time-to-peak. The aim of this study was to elucidate the artefacts in CAT when dabigatran is present.

MATERIALS AND METHODS: Thrombin generation (TG) was measured in vitro by using CAT in the presence or absence of 6 μM idarucizumab in plasma spiked with dabigatran. Additionally, ex vivo measurements were performed in plasmas of 63 patients using dabigatran in the presence and absence of idarucizumab.

RESULTS: The in vitro experiments confirmed that the ETP, peak and velocity index were artificially increased. This was mainly due to the inhibition of the calibrator by dabigatran and partly due to CAT algorithms. The calibration artefact could be resolved by adding idarucizumab to the calibrator well. However, the second, mathematical artefact remains when dabigatran is present in the TG well. These findings were corroborated by ex vivo experiments i.e. the lag time and time-to-peak were significantly reduced in patients upon addition of idarucizumab, but the ETP and peak were not significantly affected. The velocity index did change significantly, since this is a combination of time-dependent factors and the peak.

CONCLUSIONS: The peak, ETP and velocity index do not represent the anticoagulant effect of dabigatran on TG measured with CAT. The lag time and time-to-peak, however, do reflect the effect of dabigatran.

Original languageEnglish
Pages (from-to)160-166
Number of pages7
JournalThrombosis Research
Volume171
DOIs
Publication statusPublished - 1 Nov 2018

Keywords

  • Antithrombins/blood
  • Blood Coagulation/drug effects
  • Blood Coagulation Tests/methods
  • Calibration
  • Dabigatran/blood
  • Humans
  • Thrombin/analysis
  • Thrombin generation
  • Anticoagulant
  • Dabigatran
  • Idarucizumab

Fingerprint Dive into the research topics of 'The anticoagulant effect of dabigatran is reflected in the lag time and time-to-peak, but not in the endogenous thrombin potential or peak, of thrombin generation'. Together they form a unique fingerprint.

Cite this