Evidence map›Paper›PMID 25212648›Full record

ReviewJournal of the American College of Cardiology2014

Laboratory measurement of the anticoagulant activity of the non-vitamin K oral anticoagulants.

Adam Cuker, Deborah M Siegal, Mark A Crowther, David A Garcia

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of the American College of Cardiology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 141 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
141citing papers in PubMed, 5 pooled it
39.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

141 citing papers in PubMed, 5 syntheses or guidelines pooled it, 442 citations in OpenAlex.

  1. Guideline
  2. Pooled it
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  6. Estimation of Rivaroxaban Plasma Concentrations in the Perioperative Setting in Patients With or Without Heparin Bridging.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis · 2018
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  19. Use of Direct Anticoagulants in Kidney Transplant Recipients: Review of the Current Evidence and Emerging Perspectives.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2025
    Review
  20. Article

81 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 2 countries.

Adam CukerDepartment of Medicine and Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: adam.cuker@uphs.upenn.edu.
Deborah M SiegalDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.
Mark A CrowtherDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.
David A GarciaDepartment of Medicine, University of Washington, Seattle, Washington.
McMaster University · CAUniversity of Pennsylvania · USUniversity of Washington · US

Funding

Improving the diagnosis of heparin-induced thrombocytopeniaK23HL112903 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI CUKER, ADAM · 2012 to 2015
$436k
NHLBI NIH HHS HL112903NHLBI NIH HHS K23 HL112903
6 · The paper itself

Abstract

backgroundNon-vitamin K oral anticoagulants (NOACs) do not require routine laboratory monitoring. However, laboratory measurement may be desirable in special situations and populations.

objectivesThis study's objective was to systematically review and summarize current evidence regarding laboratory measurement of the anticoagulant activity of dabigatran, rivaroxaban, and apixaban.

methodsWe searched PubMed and Web of Science for studies that reported a relationship between drug levels of dabigatran, rivaroxaban, and apixaban and coagulation assay results. Study quality was evaluated using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2).

resultsWe identified 17 eligible studies for dabigatran, 15 for rivaroxaban, and 4 for apixaban. For dabigatran, a normal thrombin time excludes clinically relevant drug concentrations. The activated partial thromboplastin time (APTT) and prothrombin time (PT) are less sensitive and may be normal at trough drug levels. The dilute thrombin time (R(2) = 0.92 to 0.99) and ecarin-based assays (R(2) = 0.92 to 1.00) show excellent linearity across on-therapy drug concentrations and may be used for drug quantification. For rivaroxaban and apixaban, anti-Xa activity is linear (R(2) = 0.89 to 1.00) over a wide range of drug levels and may be used for drug quantification. Undetectable anti-Xa activity likely excludes clinically relevant drug concentrations. The PT is less sensitive (especially for apixaban); a normal PT may not exclude clinically relevant levels. The APTT demonstrates insufficient sensitivity and linearity for quantification.

conclusionsDabigatran, rivaroxaban, and apixaban exhibit variable effects on coagulation assays. Understanding these effects facilitates interpretation of test results in NOAC-treated patients. More information on the relationship between drug levels and clinical outcomes is needed.

Indexed as

Drug MonitoringAdministration, OralAnticoagulantsAntithrombinsBenzimidazolesbeta-AlanineDabigatranFactor Xa InhibitorsHumansMorpholinesPartial Thromboplastin TimePyrazolesPyridonesRivaroxabanThiophenesAnticoagulantsAntithrombinsapixabanBenzimidazolesbeta-AlanineDabigatranFactor Xa InhibitorsMorpholinesPyrazolesPyridonesRivaroxabanThiophenesapixabandabigatranlaboratorymonitoringrivaroxaban

Identifiers

PMID25212648
PMCPMC4167772
OpenAlexW2001598988

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.