Observational studyJournal of the American Heart Association2018
Limitations of Specific Coagulation Tests for Direct Oral Anticoagulants: A Critical Analysis.
Observational study in Journal of the American Heart Association, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
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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.
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.
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.
- Rapid assessment of direct oral anticoagulants in acute stroke-An educational systematic review.European stroke journal · 2025Pooled it
- Are We Overusing Coagulation Studies in the Emergency Department?Emergency medicine international · 2024Article
- Practical Nomogram Predicting Apixaban or Rivaroxaban Concentrations from Low-Molecular-Weight Heparin Anti-Xa Values: Special Interest in Acute Ischemic Stroke Patients.Journal of stroke · 2023Article
- Point-of-Care Assessment of Direct Oral Anticoagulation in Acute Ischemic Stroke: Protocol for a Prospective Observational Diagnostic Accuracy Study.Thrombosis and haemostasis · 2022Article
- Intravenous Thrombolysis With Alteplase at 0.6 mg/kg in Patients With Ischemic Stroke Taking Direct Oral Anticoagulants.Journal of the American Heart Association · 2022Observational
- Anticoagulation for atrial fibrillation in active cancer.Oncology letters · 2022Review
- Intravenous thrombolysis in patients taking direct oral anticoagulants (ESO IVT guidelines comment).European stroke journal · 2021Article
- Anticoagulation Monitoring for Perioperative Physicians.Anesthesiology · 2021Review
- Laboratory Monitoring of Direct Oral Anticoagulants (DOACs).Biomedicines · 2021Review
- Viscoelastometry for detecting oral anticoagulants.Thrombosis journal · 2021Article
- Point-of-care testing for emergency assessment of coagulation in patients treated with direct oral anticoagulants including edoxaban.Neurological research and practice · 2021Article
- Real-World Data on Characteristics and Management of Community Patients Receiving Anticoagulation Therapy Who Presented with Acute Bleeding to the Emergency Department at a Regional Australian Hospital: A Prospective Observational Study.Mediterranean journal of hematology and infectious diseases · 2021Article
- Does Exercise Influence the Susceptibility to Arterial Thrombosis? An Integrative Perspective.Frontiers in physiology · 2021Review
- Inhibition of thrombin generation 12 hours after intake of direct oral anticoagulants.Research and practice in thrombosis and haemostasis · 2020Article
- A New Test for the Detection of Direct Oral Anticoagulants (Rivaroxaban and Apixaban) in the Emergency Room Setting.Critical care explorations · 2019Article
- Patients on NOACs in the Emergency Room.Current neurology and neuroscience reports · 2019Review
- [Atypical intracerebral hemorrhage-etiology and acute management].Der Nervenarzt · 2019Article
- Limitations of Specific Coagulation Tests for Direct Oral Anticoagulants: A Critical Analysis.Journal of the American Heart Association · 2018Observational
- Performance Characteristics of DOAC Dipstick in Determining Direct Oral Anticoagulants in Urine.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisArticle
- Patients' Plasma Activity of Heparin, low-Molecular-Weight Heparin or no Anticoagulants on Urine Based DOAC Test Strips.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisArticle
Corrections and comments
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Authors and funding
11 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background During treatment with direct oral anticoagulants ( DOAC ), coagulation assessment is required before thrombolysis, surgery, and if anticoagulation reversal is evaluated. Limited data support the accuracy of DOAC -specific coagulation assays around the current safe-for-treatment threshold of 30 ng/ mL . Methods and Results In 481 samples obtained from 96 patients enrolled at a single center, DOAC concentrations were measured using Hemoclot direct thrombin inhibitor assay, Biophen direct thrombin inhibitor assay or ecarin clotting time for dabigatran, chromogenic anti-Xa assay ( AXA ) for factor Xa inhibitors (rivaroxaban, apixaban) and ultraperformance liquid chromatography-tandem mass spectrometry as reference. All dabigatran-specific assays had high sensitivity to concentrations >30 ng/ mL , but specificity was lower for Hemoclot direct thrombin inhibitor assay (78.2%) than for Biophen direct thrombin inhibitor assay (98.9%) and ecarin clotting time (94.6%). AXA provided high sensitivity and specificity for rivaroxaban, but low sensitivity for apixaban (73.8%; concentrations up to 82 ng/ mL were misclassified as <30 ng/ mL ). If no DOAC -specific calibration for AXA is available, results 2-fold above the upper limit of normal indicate relevant rivaroxaban concentrations. For apixaban, all elevated results should raise suspicion of relevant anticoagulation. Conclusions DOAC -specific tests differ considerably in diagnostic performance for concentrations close to the currently accepted safe-for-treatment threshold. Compared with Biophen direct thrombin inhibitor assay and ecarin clotting time, limited specificity of Hemoclot direct thrombin inhibitor assay poses a high risk of unnecessary anticoagulation reversal or treatment delays in patients on dabigatran. While AXA accurately detected rivaroxaban, the impact of low apixaban levels on the assay was weak. Hence, AXA results need to be interpreted with extreme caution when used to assess hemostatic function in patients on apixaban. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 02371044, NCT 02371070.
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