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Dabigatran and its reversal with recombinant factor VIIa and prothrombin complex concentrate: A Sonoclot in vitro study

Solbeck, Sacha; Nilsson, Caroline LU ; Engström, Martin LU ; Ostrowski, Sisse R. and Johansson, Par I. (2014) In Scandinavian Journal of Clinical & Laboratory Investigation 74(7). p.591-598
Abstract
Objective. Dabigatran is a new oral direct thrombin inhibitor. No specific antidote exists in the event of hemorrhage, but prothrombin complex concentrate (PCC) and recombinant activated factor VII (rFVIIa) are suggested therapies. Sonoclot is a bedside viscoelastic instrument for monitoring the coagulation process in whole blood. The aim of this study was to investigate the effect of dabigatran and reversal with PCC and rFVIIa, as monitored by the Sonoclot. Methods. Citrated whole blood was drawn and mixed in vitro with dabigatran, dabigatran + PCC or dabigatran + rFVIIa and analyzed with three different Sonoclot cuvettes: Glassbead, kaolin and tissue factor (diluted) activated. Results. The Sonoclot detected in vitro-induced... (More)
Objective. Dabigatran is a new oral direct thrombin inhibitor. No specific antidote exists in the event of hemorrhage, but prothrombin complex concentrate (PCC) and recombinant activated factor VII (rFVIIa) are suggested therapies. Sonoclot is a bedside viscoelastic instrument for monitoring the coagulation process in whole blood. The aim of this study was to investigate the effect of dabigatran and reversal with PCC and rFVIIa, as monitored by the Sonoclot. Methods. Citrated whole blood was drawn and mixed in vitro with dabigatran, dabigatran + PCC or dabigatran + rFVIIa and analyzed with three different Sonoclot cuvettes: Glassbead, kaolin and tissue factor (diluted) activated. Results. The Sonoclot detected in vitro-induced anticoagulation due to dabigatran with the glassbead- and kaolin-activated cuvettes. There was no reversing effect of PCC, probably due to the presence of heparin in the PCC we used. There was no certain reversing effect of rFVIIa. Conclusions. The Sonoclot can detect the anticoagulant effect of dabigatran. Our results do not support efficient reversal of dabigatran with PCC and rFVIIa, or alternatively do not support the ability of Sonoclot to detect a reversing effect of the PCC and rFVIIa in our study. Clinical studies of dabigatran-treated patients with severe bleeding are called for, as well as the continued development of specific antidotes and monitoring techniques. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Antithrombins, blood coagulation factors, blood coagulation tests, factor VII, hemorrhage, thrombelastography
in
Scandinavian Journal of Clinical & Laboratory Investigation
volume
74
issue
7
pages
591 - 598
publisher
Informa Healthcare
external identifiers
  • wos:000343756500006
  • scopus:84911897073
ISSN
1502-7686
DOI
10.3109/00365513.2014.921930
language
English
LU publication?
yes
id
175bb3ca-57cf-401d-b28c-ec94a6f1a56c (old id 4879063)
date added to LUP
2014-12-22 12:59:25
date last changed
2017-07-02 04:11:17
@article{175bb3ca-57cf-401d-b28c-ec94a6f1a56c,
  abstract     = {Objective. Dabigatran is a new oral direct thrombin inhibitor. No specific antidote exists in the event of hemorrhage, but prothrombin complex concentrate (PCC) and recombinant activated factor VII (rFVIIa) are suggested therapies. Sonoclot is a bedside viscoelastic instrument for monitoring the coagulation process in whole blood. The aim of this study was to investigate the effect of dabigatran and reversal with PCC and rFVIIa, as monitored by the Sonoclot. Methods. Citrated whole blood was drawn and mixed in vitro with dabigatran, dabigatran + PCC or dabigatran + rFVIIa and analyzed with three different Sonoclot cuvettes: Glassbead, kaolin and tissue factor (diluted) activated. Results. The Sonoclot detected in vitro-induced anticoagulation due to dabigatran with the glassbead- and kaolin-activated cuvettes. There was no reversing effect of PCC, probably due to the presence of heparin in the PCC we used. There was no certain reversing effect of rFVIIa. Conclusions. The Sonoclot can detect the anticoagulant effect of dabigatran. Our results do not support efficient reversal of dabigatran with PCC and rFVIIa, or alternatively do not support the ability of Sonoclot to detect a reversing effect of the PCC and rFVIIa in our study. Clinical studies of dabigatran-treated patients with severe bleeding are called for, as well as the continued development of specific antidotes and monitoring techniques.},
  author       = {Solbeck, Sacha and Nilsson, Caroline and Engström, Martin and Ostrowski, Sisse R. and Johansson, Par I.},
  issn         = {1502-7686},
  keyword      = {Antithrombins,blood coagulation factors,blood coagulation tests,factor VII,hemorrhage,thrombelastography},
  language     = {eng},
  number       = {7},
  pages        = {591--598},
  publisher    = {Informa Healthcare},
  series       = {Scandinavian Journal of Clinical & Laboratory Investigation},
  title        = {Dabigatran and its reversal with recombinant factor VIIa and prothrombin complex concentrate: A Sonoclot in vitro study},
  url          = {http://dx.doi.org/10.3109/00365513.2014.921930},
  volume       = {74},
  year         = {2014},
}