OC 51.3 - Dielectric blood coagulometry for evaluation of coagulation activity of blood samples from patients prescribed with direct oral anticoagulants undergoing elective surgeries

Tuesday, June 27, 2023

11:15 – 11:30 ET

Room: 710A

Session Available As: On-Demand

Presenting Author(s)

Aya Takemoto, MD

assistant professor
Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences
Bunky-ku, Tokyo, Japan

Co-Author(s)

NK

Nobuyo Kondo

Technical Staff
Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences
Bunky-ku, Tokyo, Japan
AK

Akiko Kitajo

Assistant Professor
Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences
Bunkyo-ku, Tokyo, Japan
HY

Hiroto Yamamoto

Senior Lecturer
Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences
Bunky-ku, Tokyo, Japan
YY

Yudai Yamamoyo

Assistant Professor
Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences
Bunky-ku, Tokyo, Japan
KH

Koji Higashino

Chief of research support team
Arkray Marketing Inc
Bunkyo-ku, Tokyo, Japan
TU

Tokujiro Uchida

Professor
Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences
Bunkyo-ku, Tokyo, Japan

Background: Dielectric blood coagulometry (DBCM) is a coagulation test based on the measurement of dielectric permittivity change, We recently developed a new cartridge to evaluate anticoagulation activity of anti Xa inhibitors, and we presented potential usefulness of this system using spiked samples (Takemoto et al. ISTH 2022).

Aims: To evaluate relationship among coagulation time measured by this system (DBCM-CT), plasma concentration of DOACs, and peak thrombin generation in the blood samples from patients undergoing elective surgeries.

Methods: This study was approved by the institutional Ethical Committee(M2020-373). After obtaining informed consent, patients prescribed with DOACs undergoing elective surgeries were included. Whole blood samples are collected (1) at the preoperative visit in the outpatient clinic, and (2) after the induction of anesthesia in the operating room. Our newly developed cartridges were used to measure DBCM-CT. Plasma was isolated, and they are used in evaluation of thrombin generation using calibrated automated thrombogram, and in vitro quantitative determination of direct Factor Xa inhibitors. Spearman’s correlation was tested to analyze correlation between DBCM-CT and plasma concentration of DOACs or peak thrombin generation. Receiver operating characteristic curve analyses were performed to evaluate diagnostic performance of this system to detect < 50ng/mL of DOACs. Statistical significance was defined as P< 0.05.

Results: DBCM-CT correlated with plasma concentration of DOACs (Rs=0.87, for apixaban [n=55, P< 0.001]; Rs=0.91 for rivaroxaban [n=46, P< 0.001], Fig 1). Peak thrombin levels showed significant correlation with DBCM CT Rs=-0.82 for apixaban [n=55, P< 0.001]; Rs=-0.84 for rivaroxaban [n=46, P< 0.001], Fig 2). ROC analysis for detection of samples < 50ng/mL of DOACs showed area under the curve of 0.97 (95% confidence interval (CI) 0.94-1.0) for apixaban and 0.99 (95%CI 0.98-1.0) for rivaroxaban.

Conclusion(s): These results suggest clinical usefulness of DBCM as a point of care test to evaluate anticoagulation induced by DOACs.

Learning Objectives:

understand methodology of dielectric blood coagulometry (DBCM), and its usefulness in the evaluation of residual anticoagulation potential in the blood sampled from patients prescribed with direct oral anticoagulants.
understand that coagulation time measured by DBCM reflects peak value of thrombin generation quantified by the calibrated automated thrombogram.
understand the distribution of plasma levels of DOACs in perioperative period in the study population, and discuss necessity of DOAC monitoring to prevent both bleeding and thromboembolic complications.