Semin Thromb Hemost 2013; 39(01): 066-071
DOI: 10.1055/s-0032-1331155
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Novel Methods for Assessing Oral Direct Factor Xa and Thrombin Inhibitors: Use of Point-of-Care Testing and Urine Samples

Job Harenberg
1  Department of Clinical Pharmacology Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
,
Shanshan Du
1  Department of Clinical Pharmacology Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
,
Sandra Krämer
1  Department of Clinical Pharmacology Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
,
Christina Giese
1  Department of Clinical Pharmacology Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
,
Astrid Schulze
2  Department of Orthopedic and Trauma Surgery, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
,
Christel Weiss
3  Department of Biometry and Statistics, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
,
Roland Krämer
4  Inorganic Chemistry Institute, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
27 December 2012 (online)

Abstract

Rivaroxaban and dabigatran are new oral anticoagulants (NOACs) that inhibit directly factor Xa and thrombin, respectively. These NOACs effectively prevent thromboembolic complications using fixed doses without the need for dose adjustment according to laboratory results. About 60% of rivaroxaban is cleared from circulation by glomerular filtration, 30% of which is excreted as active drug. About 80% of dabigatran is excreted into urine as active compound. Accordingly, both NOACs can be determined in urine by means of chromatographic methods. Only a few laboratories are able to perform such methods, and results are not available within short time frames. New methods have to be developed to obtain results within minutes and possibly as point-of-care (POC) techniques. This testing may be useful for special patient populations such as those with acute deterioration of renal function due to any disease, before surgical interventions, during unexpected bleeding or thrombotic episodes while on therapy with NOACs, the oldest and youngest populations, pregnancy, suspicion of overdose and intoxication, and to determine adherence to therapy. Here we describe results of a POC qualitative assay using urine samples from patients on treatment with dabigatran and rivaroxaban.