The maximum percentage reversal of the anticoagulant effect of dabigatran within 4 hours after the administration of idarucizumab was 100% [95% confidence interval (CI): 100-100] on the basis of the diluted thrombin time or ecarin clotting time
. Also, it was shown that the percentage reversal of the anticoagulant effect was independent of age, sex, kidney functions, and the level of dabigatran at initiation.
However, ecarin clotting time
(ECT) and diluted thrombin time (dTT), tests which are not widely available, are more sensitive and accurate measures of dabigatran activity and idarucizumab effectiveness [14, 15].
(13) Less widely available tests, including thrombin time, ecarin clotting time, Heptest (American Diagnostica, Stamford, Connecticut), prothrombinase-induced clotting time, and chromogenic factor IIa, either do not correlate well with drug levels or are cumbersome and lengthy to perform.
Other assays such as ecarin clotting time and chromogenic anti-factor IIa are not readily available and/or have not been specifically studied with dabigatran.
The ecarin clotting time
(ECT) is a global test that reflects the activity of the coagulation cascade downstream from FII (15).
ACT: activated clotting time; aPTT: activated partial thromboplastin time; CPB: cardiopulmonary bypass; ECT: Ecarin clotting time
; HIT: Heparin- induced thrombocytopenia; PCI: percutaneous coronary intervention.
Most cardiac surgical units are not equipped with an ecarin clotting time
point-of-care analyser (specific for bivalirudin) (11), although use of plasma modified ACT has been described (12).
The first diagnostic test, the Ecarin Clotting Time
("ECT") test, was developed to monitor the effect of Knoll's thrombin inhibitor PEG Hirudin.
Ecarin clotting time
(ECT) assays can be used to monitor DTI levels, including argatroban.
The authors are to be congratulated for their successful outcome and their detailed description of the modified ecarin clotting time
(ECT) used to monitor the anticoagulation.
Simultaneous measurements of PT and of the concentrations of the DTIs by specific coagulation testing methods (e.g., ecarin clotting time
), chromogenic (S-2238), ELISA, or chromatographic assays may improve judgment about the correct dosing during periods of concomitant therapy with vitamin K antagonists and DTIs.
(3) Nonstandard abbreviations: POC, point of care; PIOP, paramagnetic iron oxide particles; ECT, ecarin clotting time
; PEG, polyethylene glycol; LOT, lysis onset time; t-PA, tissue plasminogen activator; and TAS, Thrombolytic Assessment System.