Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Dr. Franz Rehrl Platz 5, 5020, Salzburg, Austria.
Paracelsus Medical University, Salzburg, Austria.
Eur J Trauma Emerg Surg. 2023 Dec;49(6):2543-2551. doi: 10.1007/s00068-023-02334-5. Epub 2023 Jul 27.
Due to a better safety profile, direct oral anticoagulants (DOACs) are increasingly prescribed for prevention of thromboembolic events. However, little is known about DOAC plasma concentrations in trauma patients upon hospital admission. Thus, we investigated the frequency and extent of DOAC possible over- and underdosing in trauma patients upon hospital admission.
In this single-center retrospective study, DOAC plasma concentrations of adult trauma patients were analyzed with specific calibrated anti-IIa (dabigatran) and anti-Xa (apixaban, edoxaban and rivaroxaban) tests within 4 h after hospital admission.
A total of 210 trauma patients, admitted between 2019 and 2022, were included in the analyses. Low DOAC levels < 30 ng/mL were detected in 13.3% of the patients. In 7.1% of the patients, DOAC plasma levels ranged between 300-399 ng/mL and further 7.1% exhibited plasma concentrations > 400 ng/mL. The highest incidence of high to very high DOAC plasma concentration was observed for patients on rivaroxaban and dabigatran. A moderate correlation was observed between dabigatran plasma concentration and estimated glomerular filtration rate (rho = - 0.5338, p = 0.0003). For rivaroxaban no clear association between plasma concentration and liver or renal function could be detected. Patients on statins had significantly higher DOAC concentration in comparison with those not taking statins (153 (76-274) vs 108 (51-217) ng/mL, p = 0.046).
The current study revealed that patients on dabigatran and rivaroxaban were prone to higher DOAC plasma levels upon hospital admission in comparison with apixaban and edoxaban. DOAC plasma level measurement in trauma patients might be warranted due to unpredictively low or high plasma concentrations. However, the clinical impact of altered plasma levels on both, bleeding and thromboembolic events, remains to be determined by future studies.
由于更好的安全性，直接口服抗凝剂（DOAC）越来越多地用于预防血栓栓塞事件。然而，关于创伤患者入院时 DOAC 血浆浓度知之甚少。因此，我们研究了创伤患者入院时 DOAC 可能出现的剂量过高和过低的频率和程度。
在这项单中心回顾性研究中，在创伤患者入院后 4 小时内，使用特定的校准抗-IIa（达比加群）和抗-Xa（阿哌沙班、依度沙班和利伐沙班）检测分析成年创伤患者的 DOAC 血浆浓度。
共纳入 210 名 2019 年至 2022 年期间入院的创伤患者进行分析。13.3%的患者 DOAC 水平较低（<30ng/mL）。7.1%的患者 DOAC 血浆水平在 300-399ng/mL 之间，进一步有 7.1%的患者表现出浓度>400ng/mL。利伐沙班和达比加群的患者发生高至极高 DOAC 血浆浓度的发生率最高。达比加群的血浆浓度与估算的肾小球滤过率（rho=-0.5338，p=0.0003）之间存在中度相关性。对于利伐沙班，未发现血浆浓度与肝功能或肾功能之间有明确的关联。与未服用他汀类药物的患者相比，服用他汀类药物的患者 DOAC 浓度显著更高（153（76-274）比 108（51-217）ng/mL，p=0.046）。
与阿哌沙班和依度沙班相比，当前研究显示，入院时达比加群和利伐沙班的患者更易出现较高的 DOAC 血浆水平。由于血浆浓度不可预测地降低或升高，可能需要对创伤患者进行 DOAC 血浆水平检测。然而，改变的血浆水平对出血和血栓栓塞事件的临床影响仍有待未来研究确定。
