40 - Oral Communication
Critical Care, Surgery & Transfusion medicine
Feb. 24, 2021, 1:45 p.m. - 3:15 p.m., Barcelona
Assessment of the anticoagulant effect of direct oral anticoagulants (DOACs) in patients needing immediate management during emergency procedures
M. Caspers, S. Roeschl, J. Holle, H. Bendella, Presenter: M. Caspers (Cologne)
Background and Objective
Assessment of the anticoagulant effect of direct oral anticoagulants (DOACs) still is a challenge for various medical disciplines, especially in patients needing immediate care in a medical emergency. Aside from severe bleeding and thrombotic events, evaluation of the coagulation status is important for urgent indication of fracture care or administration of a specific antidot. An assay that screens for the absence of a DOAC might help accelerate treatment in these situations. The goal of this study is to evaluate the use of a qualitative POC Method (DOAC Dipstick, DOASENSE®) in an emergency setting.
Between 11/2019 and 04/2020 the POC method was available for all clinicians in a level I emergency department. The POC testing was indicated by the physician on duty followed by a standardized questionnaire on basic patients’ parameters, indication for the qualitative testing and drawn conclusions based on the tests´ results. Intraindividual reliability blinded to the clinical user (visual testing vs. semiquantitative reader) as well as the interindividual reliability compared with standard anti-factor-Xa (antiXa)- or direct-thrombin-inhibitor (DTI)-tests were investigated.
In total, 82 patients were included (30% Neurology, 50% Trauma, 10% Neurosurgery, 10% Internal Medicine) 28 patients being anticoagulated with antiXa inhibitor and 7 patients with dabigatran. Test results of POC testing could be confirmed using standard anti-factor-Xa (antiXa)- or direct-thrombin-inhibitor (DTI)-tests in all cases. In most cases the POC test was used to identify unknown DOAC status in patients who could not be interviewed concerning their medication. 12 patients received a lysis therapy after exclusion of DOAC anticoagulation, 2 patients were treated with a specific antidot after a major bleeding event. In 6 patients the POC test demonstrated a positive result in patients that stopped using the oral medication several days ago.
In an emergency with an immediate consequence under time pressure, the POC test might provide a significant time advantage compared to standard laboratory testing. Due to the cumulative effect within the patients´ urine the test can only be used for the qualitative verification and does not provide any information concerning the actual anticoagulative effect.