Global thromboelastometry in patients receiving direct oral anticoagulants: the RO-DOA study

  • Maria Cristina VedovatiEmail author
  • Maria Giulia Mosconi
  • Federico Isidori
  • Giancarlo Agnelli
  • Cecilia Becattini


Rapidly available tests might be useful to measure the anticoagulant effect of direct oral anticoagulants (DOAs) in emergency situations as bleedings, surgery, or before thrombolysis. The aim of this study was to assess the effects of DOAs on global thromboelastometry (ROTEM). Coagulation parameters assessed at peak and trough in patients with non-valvular atrial fibrillation receiving apixaban, dabigatran or rivaroxaban at steady-state (patients) were compared to those of healthy volunteers (controls). Citrated blood samples were tested by ROTEM using diluted EXTEM assay, with and without the addition of an anti-FXa catcher, and using ECATEM-B, with and without the addition of an anti-FIIa catcher. Overall 30 patients (10 for each DOA) and 15 controls were included. The mean clotting time (CT) of patients at peak and trough were significantly higher compared to controls. The mean CT was significantly shortened after the addition of the anti-FXa catcher to apixaban (p = 0.005 for peak and p = 0.009 for trough) and to rivaroxaban samples (p = 0.005 for both peak and trough) and after the addition of anti-FIIa cather to dabigatran samples (p = 0.005 for both peak and trough). ROC curve analyses showed a good accuracy for CT and for CT/CT + catcher (CTc) in measuring dabigatran anticoagulant activity (AUC 1.000 and 0.993, respectively); for CT, CT/CTc and clot formation time (CFT)/CFT + catcher (CFTc) in measuring both apixaban activity (0.917, 0.880 and 0.880, respectively) and rivaroxaban activity (0.973, 0.987 and 0.860, respectively). In this study the use of ad-hoc designed reagents and catcher molecules was able to accurately identify DOAs activity at ROTEM.


Anticoagulants Apixaban Dabigatran Emergencies Rivaroxaban Thrombelastography 



We thank Tem Innovations GmbH for providing reagents free of charge.

Compliance with ethical standards

Conflict of interest

G.A. reports consulting fees from Bayer, Boehringer Ingelheim, and Daiichi Sankyo, lecture fees from Bristol-Myers Squibb and Sanofi-Aventis. C.B. reports lecture fees from Boehringer Ingelheim, Daiichi Sankyo and Bristol-Myers Squibb. M.C.V., M.G.M. and F.I. have no disclosures.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Maria Cristina Vedovati
    • 1
    Email author
  • Maria Giulia Mosconi
    • 1
  • Federico Isidori
    • 1
  • Giancarlo Agnelli
    • 1
  • Cecilia Becattini
    • 1
  1. 1.Internal Vascular and Emergency Medicine - Stroke UnitUniversity of PerugiaPerugiaItaly

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