Evaluation of the MRX PT DOAC assay for detection of clinically relevant factor Xa inhibitor drug levels.

IF 5.5 2区 医学 Q1 HEMATOLOGY Journal of Thrombosis and Haemostasis Pub Date : 2024-12-13 DOI:10.1016/j.jtha.2024.12.005
Brittany Salter, Karen Moffat, Stephen Carlino, Jackie Dobson-Storr, Lee Beckett, Emma Broomhead, Liselotte Onelöv, Sarah Ge, Marina Atalla, Raymond Melika, Saumya Bansal, Steven Kitchen, Mark Crowther, Siraj Mithoowani
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Abstract

Background: Although routine monitoring is not needed for DOACs, knowing if a clinically relevant DOAC level is present can be critical, especially in cases of severe bleeding or urgent surgery. Rapid assays to exclude these levels are necessary but not widely available.

Methods: The MRX PT DOAC assay measures the functional effect of DOACs using the clot-time ratio; a ratio between DOAC-sensitive prothrombin time (PT) and DOAC-insensitive PT. We conducted a multi-center retrospective study of 152 samples from 151 patients with known DOAC levels to assess whether the MRX PT DOAC assay could exclude clinically relevant drug levels of >50 ng/mL, and whether test performance differed across coagulation analyzers. To assess generalizability, the assay was run on four coagulation analyzers: Werfen ACLTOP 750, Diagnostica Stago STACompact MAX, Sysmex CS2500, and Sysmex CN-6000.

Results: The MRX PT DOAC assay had a sensitivity of 100% with a confidence interval (CI) of 70-100% and negative predictive value (NPV) of 100% (CI:57-100%) for edoxaban drug levels >50 ng/mL. For rivaroxaban, sensitivity was 100% (CI:61-100%) and NPV was 100% (CI:5-100%). For apixaban, sensitivity ranged from 59% to 83% (CI:41-93%) and NPV ranged from 0% to 50% (CI:0-69%). The specificity of the assay ranged from 61% to 86% (CI:39-93%) for apixaban, 36% to 50% (CI:3-95%) for edoxaban, and 75% to 100% (CI:30-100%) for rivaroxaban.

Conclusion: The MRX PT DOAC assay reliably excludes clinically relevant DOAC levels edoxaban and rivaroxaban, across multiple analyzers, but not for apixaban.

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评估 MRX PT DOAC 检测法用于检测临床相关的 Xa 因子抑制剂药物水平。
背景:虽然 DOACs 不需要常规监测,但了解是否存在与临床相关的 DOAC 水平至关重要,尤其是在严重出血或紧急手术的情况下。排除这些水平的快速检测方法很有必要,但并不普及:方法:MRX PT DOAC 检测法使用凝血时间比值(DOAC 敏感的凝血酶原时间(PT)与 DOAC 不敏感的 PT 之间的比值)测量 DOAC 的功能效应。我们对 151 名已知 DOAC 水平的患者的 152 份样本进行了多中心回顾性研究,以评估 MRX PT DOAC 检测是否能排除临床相关的 >50 纳克/毫升的药物水平,以及不同凝血分析仪的检测性能是否存在差异。为了评估通用性,该测定在四种凝血分析仪上运行:Werfen ACLTOP 750、Diagnostica Stago STACompact MAX、Sysmex CS2500 和 Sysmex CN-6000:MRX PT DOAC测定对依多沙班药物水平>50纳克/毫升的灵敏度为100%,置信区间(CI)为70-100%,阴性预测值(NPV)为100%(CI:57-100%)。利伐沙班的灵敏度为 100%(CI:61-100%),阴性预测值为 100%(CI:5-100%)。阿哌沙班的灵敏度为 59% 至 83%(CI:41-93%),NPV 为 0% 至 50%(CI:0-69%)。阿哌沙班的特异性为61%至86%(CI:39-93%),依度沙班的特异性为36%至50%(CI:3-95%),利伐沙班的特异性为75%至100%(CI:30-100%):结论:MRX PT DOAC 检测能在多个分析仪上可靠地排除埃多沙班和利伐沙班的临床相关 DOAC 水平,但不能排除阿哌沙班的临床相关 DOAC 水平。
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来源期刊
Journal of Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis 医学-外周血管病
CiteScore
24.30
自引率
3.80%
发文量
321
审稿时长
1 months
期刊介绍: The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.
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