Evrard Jonathan, Siriez Romain, Bouvy Céline, Favresse Julien, Yildiz Halil, Hainaut Philippe, Mullier François, Dogné Jean-Michel, Douxfils Jonathan
Department of Pharmacy Université de Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS) Namur Belgium.
Qualiblood s.a. Namur Belgium.
Res Pract Thromb Haemost. 2022 Nov 4;6(7):e12804. doi: 10.1002/rth2.12804. eCollection 2022 Oct.
The activated partial thromboplastin time (aPTT) and the prothrombin time (PT) are widely available coagulation parameters which are however poor predictors of the anticoagulant effect of direct oral anticoagulants (DOACs). Some coagulometers use the clot waveform analysis (CWA) to assess the clotting time but mainly based on a unique parameter. The improvement of these methodologies and the evaluation of the other waveform parameters may increase the sensitivity to DOACs.
To assess the performance of an improved clot waveform an method (i.e. FibWave) to detect the impact of edoxaban on the coagulation and the fibrinolytic systems.
Seventy-one samples from patients treated with edoxaban collected at minimum concentration (C) and/or maximum concentration (C), and 45 control samples were included. The aPTT- and PT-based CWA as well as the FibIn, FibEx, and FibLysis methodologies of the FibWave were implemented and performed on an ACL-TOP 700.
PT and FibEx clotting time were strongly correlated to edoxaban concentration (Pearson = 0.80 and 0.89, respectively). The FibEx clotting time allowed a better discrimination for samples with 30 and 50 ng/ml of edoxaban compared to PT (cutoffs of 96.5 and 114.2 s for the FibEx versus a unique cutoff of 13.1 s for the PT). The fibrinolytic process was impaired in the presence of edoxaban in a dose-dependent manner.
FibEx is more sensitive than aPTT- and PT-based CWA for the detection of the clinically relevant anticoagulant level of edoxaban.
活化部分凝血活酶时间（aPTT）和凝血酶原时间（PT）是广泛使用的凝血参数，然而，它们对于直接口服抗凝剂（DOACs）的抗凝效果预测能力较差。一些凝血仪使用凝血块波形分析（CWA）来评估凝血时间，但主要基于单一参数。改进这些方法并评估其他波形参数可能会提高对DOACs的敏感性。
评估一种改进的凝血块波形分析方法（即FibWave）检测依度沙班对凝血和纤溶系统影响的性能。
纳入71例接受依度沙班治疗患者在最低浓度（C）和/或最高浓度（C）时采集的样本，以及45例对照样本。在ACL-TOP 700上实施并执行基于aPTT和PT的CWA以及FibWave的FibIn、FibEx和FibLysis方法。
PT和FibEx凝血时间与依度沙班浓度密切相关（Pearson相关系数分别为0.80和0.89）。与PT相比，FibEx凝血时间对依度沙班浓度为30和50 ng/ml的样本具有更好的区分能力（FibEx的截断值为96.5和114.2秒，而PT的唯一截断值为13.1秒）。在依度沙班存在的情况下，纤溶过程以剂量依赖方式受损。
在检测依度沙班临床相关抗凝水平方面，FibEx比基于aPTT和PT的CWA更敏感。
