Why did you (and your colleagues) write this paper? What was its main purpose?

FLORIAN HÄRTIG

In clinical practice, emergency care physicians are ever more frequently confronted with stroke patients treated with the direct oral anticoagulants (DOAC) dabigatran, apixaban, edoxaban, and rivaroxaban. Knowing their coagulation status is crucial prior to making treatment decisions such as administering intravenous thrombolysis or specific antidotes like Praxbind.

My co-authors and I believe that the only way to provide adequate care to those patients in the emergency situation is by using accurate point-of-care coagulation tests. The Helena Laboratories Direct Thrombin Monitoring test card may enable us to do so.

What are the main conclusions? 

FLORIAN HÄRTIG

Our main conclusion is that the ecarin clotting time provided by the Direct Thrombin Monitoring test assay has a strong linear correlation with - and thus accurately reflects - actual dabigatran plasma concentrations; not only when using whole blood but also citrated whole blood and citrated plasma. In addition, it can be used to monitor the reversal of dabigatran with idarucizumab.

What are the paper's implications? - to the public? -to medical professionals?

FLORIAN HÄRTIG

Our group of authors is convinced that the Direct Thrombin Monitoring point-of-care test assay is a suitable diagnostic tool in any emergency department dealing with stroke patients and such with acute major or life threatening bleeding complications. For the public, the approval of the assay by the competent authorities and its widespread application would mean a leap forward in terms of safety of DOAC use. For medical professionals, having such a device to hand means faster and better informed decision making in an oftentimes critical clinical situation.

Are the findings clinically significant? Should the findings change practice?

FLORIAN HÄRTIG

Given the ever increasing number of DOAC-treated patients on the one hand, and the lack of point-of-care test assays specifically designed to assess these patients' coagulation status on the other, our findings address a clear gap in current emergency care. We believe that, in future, fast and accurate point-of-care coaguation assessment should become the standard of practice for all DOAC-treated patients prior to intravenous thrombolysis or reversal therapy in case of major or life-threatening bleeding complications.