Körber Mareike Kristina, Langer Elisabeth, Köhr Martin, Wernecke Klaus-Dieter, Korte Wolfgang, von Heymann Christian
Department of Anesthesiology and Intensive Care Medicine, Charité -Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Labor Berlin - Charite Vivantes GmbH Berlin, Berlin, Germany.
Transfus Med Hemother. 2017 Apr;44(2):100-105. doi: 10.1159/000470622. Epub 2017 Mar 27.
An increasing number of oral anticoagulants has been approved, including dabigatran etexilate (DE). DE is a direct thrombin inhibitor that requires no routine monitoring, but, if necessary (e.g. urgent surgery etc.), the diluted thrombin time measured with Hemoclot® has shown reliable results. So far, no point-of-care (PoC) assay is available to measure DE effects. The EcaTEM assay uses ecarin to initiate the coagulation cascade at the step of thrombin generation and measures the clotting time (CT) by thromboelastometry.
This study investigated the correlation of the EcaTEM with standard laboratory assays in dabigatran-treated patients. Ten patients undergoing total hip or knee arthroplasty were included in the study. DE for thromboprophylaxis was started 4 h after surgery. Blood samples were taken before surgery as well as 2, 6 and 12 h after ingestion on the 3rd postoperative day. Dabigatran concentration (Hemoclot), activated partial thromboplastin time, thrombin time and CT EcaTEM were measured.
Only CT EcaTEM and Hemoclot showed a correlation > 0.75 for all measurements.
CT EcaTEM appears a valid PoC method parameter to detect thrombin inhibition and thus the presence of dabigatran beside diluted thrombin time at different concentration levels. This may represent an opportunity to identify the presence of dabigatran, e.g., in emergency situations.
已批准的口服抗凝剂数量不断增加，包括达比加群酯（DE）。DE是一种直接凝血酶抑制剂，无需常规监测，但在必要时（如紧急手术等），使用Hemoclot®测定的稀释凝血酶时间已显示出可靠的结果。到目前为止，尚无即时检验（PoC）检测方法可用于测量DE的效果。EcaTEM检测使用蛇毒凝血酶在凝血酶生成步骤启动凝血级联反应，并通过血栓弹力图法测量凝血时间（CT）。
本研究调查了EcaTEM与接受达比加群治疗患者的标准实验室检测之间的相关性。研究纳入了10例行全髋关节或膝关节置换术的患者。术后4小时开始使用DE进行血栓预防。在手术前以及术后第3天服药后2、6和12小时采集血样。测量达比加群浓度（Hemoclot）、活化部分凝血活酶时间、凝血酶时间和EcaTEM的CT。
在所有测量中，仅EcaTEM的CT与Hemoclot显示出相关性>0.75。
EcaTEM的CT似乎是一种有效的PoC方法参数，可用于检测凝血酶抑制作用，从而在不同浓度水平下检测到达比加群的存在，这可能为在紧急情况下识别达比加群的存在提供了契机。
