Does the Russell Viper Venom time test provide a rapid estimation of the intensity of oral anticoagulation? A cohort study.

Abstract

BACKGROUND Dilute Russell Viper Venom Time (DRVV-T) might be useful in urgent settings for screening patients on Non-VKA Oral Anticoagulants (NOACs). AIM To compare the accuracy of DRVV-T with gold standard assays for the assessment of pharmacodynamics of dabigatran, rivaroxaban and vitamin K antagonist (VKA) in plasma samples from patients. METHODS Sixty rivaroxaban, 48 dabigatran and 50 VKA samples from patients were included. DRVV-T was performed in all groups using STA®-Staclot®DRVV-Screen and -Confirm. For NOACs, PT and aPTT were performed using different reagents while plasma drug concentrations were measured by liquid mass-spectrometry (LC-MS/MS). For VKA, INR was performed using RecombiPlasTin 2G®. RESULTS For NOACs, correlations between calibrated STA®-Staclot®DRVV-Confirm and LC-MS/MS (rs=0.88 and 0.97 for rivaroxaban and dabigatran, respectively) were higher than the ones obtained with STA®-Staclot®DRVV-Screen (rs=0.87 and 0.91), PT (rs=0.83 to 0.86) or aPTT (rs=0.84 to 0.89). Bland Altman analyses showed that calibrated DRVV-T methods tend to overestimate plasma concentrations of NOACs. ROC curves revealed that cut-off to exclude supra-therapeutic levels at Ctrough (i.e. 200ng/mL) are different for dabigatran and rivaroxaban. Neither STA®-Staclot®DRVV-Screen nor -Confirm correlated sufficiently with the intensity of VKA therapy (rs=0.35 and 0.52). CONCLUSIONS STA®-Staclot®DRVV-Confirm provides a rapid estimation of the intensity of anticoagulation with rivaroxaban or dabigatran without specific calibrators. At Ctrough, thresholds for rivaroxaban and dabigatran can be used to identify supra-therapeutic plasma level. However, this test cannot differentiate the nature of the NOACs. The development of a point-of-care device optimising this method would be of particular interest in emergency situations.

DOI: 10.1016/j.thromres.2015.02.020

Cite this paper

@article{Douxfils2015DoesTR, title={Does the Russell Viper Venom time test provide a rapid estimation of the intensity of oral anticoagulation? A cohort study.}, author={Jonathan Douxfils and Bernard Chatelain and Paul Hjemdahl and B{\'e}rang{\`e}re Devalet and Anne-Laure Sennesael and Pierre E Wallemacq and Yuko R{\"{o}nquist-Nii and Anton Pohanka and J M Dogn{\'e} and François Mullier}, journal={Thrombosis research}, year={2015}, volume={135 5}, pages={852-60} }