INTRODUCTIONThe direct thrombin inhibitor dabigatran has been the first direct oral anticoagulant (DOAC) approved for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation and for prevention or treatment of venous thromboembolism. Although dabigatran was developed for fixed‐dose administration in patients with standard conditions without the need of routine laboratory monitoring and dose adjustment, there is now the widespread awareness that some clinical situations, such as adverse (thrombotic/hemorrhagic) events or emergency invasive procedures and others, might require the measurement of the drug plasma levels.The global coagulation test activated partial thromboplastin time (aPTT) was initially indicated as the method to measure the degree of anticoagulation in patients treated with dabigatran due to its wide availability and low cost. However, recent studies showed that aPTT has a low sensitivity to dabigatran levels and different responsiveness depending on commercial reagents. Furthermore, normal results are not always associated with the absence or minimal residual concentration of the drug. Over the last years, several manufacturers developed specific functional tests for dabigatran plasma levels assessment, including thrombin‐based clotting assays and ecarin clotting time or chromogenic assays. These methods showed good agreement with liquid chromatography‐tandem mass spectrometry (LC‐MS/MS) that is considered as the
International Journal of Laboratory Hematology – Wiley
Published: Jan 1, 2018
Keywords: ; ; ; ;
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