Evidence map›Paper›PMID 40401656›Full record

SynthesisEuropean stroke journal2025

Rapid assessment of direct oral anticoagulants in acute stroke-An educational systematic review.

Joshua Mbroh, Ingvild Birschmann, Matthias Ebner, Johanna A Kremer Hovinga, Edelgard Lindhoff-Last, Jan Purrucker, Simon T Schäfer, Johannes Tünnerhoff, Yi Wang, Sven Poli

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European stroke journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
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

4 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Joshua MbrohDepartment of Neurology & Stroke, University of Tübingen, Tübingen, Germany.ORCID 0000-0002-0108-9161
Ingvild BirschmannInstitute for Laboratory and Transfusion Medicine, Heart and Diabetes Center, Ruhr University, Bad Oeynhausen, Germany.
Matthias EbnerDeutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany.
Johanna A Kremer HovingaDepartment of Hematology and Central Hematology Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland.
Edelgard Lindhoff-LastVascular Center, Coagulation Center and Coagulation Research Center, CardioAngiology Center (CCB) Bethanienhospital, Frankfurt, Germany.
Jan PurruckerDepartment of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Simon T SchäferDepartment of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, University Hospital, Carl-von-Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany.
Johannes TünnerhoffDepartment of Neurology & Stroke, University of Tübingen, Tübingen, Germany.
Yi WangDepartment of Neurology & Stroke, University of Tübingen, Tübingen, Germany.
Sven PoliDepartment of Neurology & Stroke, University of Tübingen, Tübingen, Germany.ORCID 0000-0002-0286-8781

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo provide an overview on commercially available point-of-care tests (POCT) for rapid assessment of direct oral anticoagulant (DOAC) activity, their diagnostic accuracy in identifying blood samples containing clinically relevant DOAC concentrations, and guidance on selecting the appropriate POCT system/assay for decision-making in emergencies.

methodsSystematic review with PubMed and Cochrane library search for published studies until September 6, 2024. Papers were included if in English, original research using blood samples from DOAC patients and POCT was implemented. Two reviewers assessed studies for eligibility and quality. Data from studies were aggregated and diagnostic accuracy at DOAC plasma thresholds of 30/50/100 ng/ml was recalculated.

findings16 studies involving four commercially available POCT systems/assays were identified. Eleven studies evaluated blood-based POCT and five used urine for indirect estimation of DOAC plasma levels. DISCUSSION: DOAC Dipsticks do not require knowledge about the taken DOAC, but measure urine and, due to low specificity, require blood testing in case of positive results. Hemochron Signature Elite (HSE) and CoaguChek use global coagulation assays and provide high sensitivity for edoxaban and rivaroxaban, HSE additionally for dabigatran. Due to insufficient correlation, both POCT are not recommended for apixaban, CoaguChek also not for dabigatran. The thromboelastometric ClotPro performs well for all DOAC, does not require knowledge about the DOAC, but was taken off the market recently.

conclusionStudies have shown feasibility of POCT in identifying blood samples containing clinically relevant DOAC plasma concentrations. Each POCT device has its own unique limitations. Knowledge about the POCT assays, time since last intake and type of DOAC enhances confidence in making appropriate therapeutic decisions. We propose an algorithm that could help guiding physicians in selecting an appropriate POCT system/assay in DOAC-related emergencies.

Indexed as

AnticoagulantsPoint-of-Care TestingStrokeAdministration, OralBlood Coagulation TestsHumansPoint-of-Care SystemsRivaroxabanAnticoagulantsRivaroxabandirect oral anticoagulantsDOACNOACnon-vitamin K antagonist oral anticoagulantsPOCTpoint-of-care test

Identifiers

PMID40401656
PMCPMC12098315

What OpenQuestion holds

Textmetadata
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.