Haematology Department, ACT Pathology, Woden, ACT, Australia.
Australian National University Medical School, Acton, ACT, Australia.
Eur J Haematol. 2018 Jun;100(6):567-574. doi: 10.1111/ejh.13050. Epub 2018 Mar 30.
To evaluate the dilute Russell viper venom time (DRVVT) for the detection of direct-acting oral anticoagulants (DOACs) and to investigate the effect of DOACS on coagulation assays.
Patients with DOACs and controls had plasma levels determined by an anti-Xa assay and dilute thrombin clotting time (TCT). Levels were correlated with the DRVVT as well as TCT, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, protein C, protein S and antithrombin levels. The utility of the DRVVT for detecting clinically significant levels of DOACs was evaluated.
There were 44 samples from patients taking dabigatran, 83 with rivaroxaban, 18 with apixaban and 55 controls. The PT and APTT failed to detect clinically significant doses of anticoagulants adequately. The TCT was increased in patients taking dabigatran and normal in controls and patients on FXa inhibitors. There was a linear correlation with all DOAC levels and the DRVVT, with moderate precision, but it showed high sensitivity (95%) and specificity (90%) for clinically significant DOAC levels.
The DRVVT detects clinically significant levels of DOACs and, in conjunction with the TCT, may be used as a screen for the presence and type of DOAC.
评估稀释 Russell 蝰蛇 venom 时间（DRVVT）检测直接作用口服抗凝剂（DOACs）的效果，并研究 DOACs 对凝血检测的影响。
通过抗-Xa 检测和稀释凝血酶时间（TCT）确定 DOAC 患者和对照组的血浆水平。将水平与 DRVVT 以及 TCT、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原、蛋白 C、蛋白 S 和抗凝血酶水平相关联。评估 DRVVT 检测临床显著 DOAC 水平的效用。
有 44 份来自服用达比加群的患者样本，83 份来自服用利伐沙班的患者样本，18 份来自服用阿哌沙班的患者样本和 55 份对照组样本。PT 和 APTT 不能充分检测到临床显著剂量的抗凝剂。服用达比加群的患者 TCT 升高，而对照组和服用 FXa 抑制剂的患者 TCT 正常。DRVVT 与所有 DOAC 水平均呈线性相关，具有中等精度，但对临床显著 DOAC 水平具有高灵敏度（95%）和特异性（90%）。
DRVVT 检测到临床显著的 DOAC 水平，与 TCT 联合使用，可作为 DOAC 存在和类型的筛选工具。
