Another post from Bob Gosselin (we hit the mother lode today!):
GF: Re dabigatran clearing in 24 hours: This is not necessarily so, depending on the patient, as we have seen “dabi” levels (q12 drug) with trough before next dose of ~150ng/mL. So I would highly suggest using thrombin times for assessing the clearing of drug, as most commercial methods for TT measurement go >150 secs with relatively little amount of drug (~50-75 ng/ml). Thereby the TT test is more sensitive to dabi than aPTTs and could/should be used in concert with aPTT for assessing drug level, especially if determining whether drug level is low enough for interventional or thrombolytic therapy.
Robert Gosselin, CLS
Coagulation Specialist, University of California, Davis Health System
Department of Pathology and Laboratory Medicine, Specialty Testing Center
Thanks, Bob, a great recommendation. Hyphen has developed their Hemoclot Thrombin Inhibitor Kit, which is a dilute thrombin time, and are marketing it for dabigatran monitoring as it is a linear measure. All the new direct thrombin inhibitor assays, including Stago’s Ecarin time and Ecarin chromogenic assay remain research use only (RUO) while the FDA ponders their applications.
George, at the present time we run a regular thrombin time o
George, at the present time we run a regular thrombin time on patients taking dabigatran who are going for surgery. Patients are asked to stop taking the drug for about 48 hours. If the TT is normal, then there is no dabigatran on-board.
(This comment is from Dr. Larry Smith at Memorial Sloan-Kettering). Thank you Larry, I plan to incorporate your suggestion into my talks in Detroit (ASCLS-MI, Plymouth Michigan) on April 18 and St. Louis (MoCLS), April 19.