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Ecarin clotting time can be used to monitor the effect of this drug, but neither the PT nor the activated partial thromboplastin time (aPTT) can be used, as there is no linear correlation between dabigatran concentration and aPTT levels.
This was determined by the diluted thrombin time or ecarin clotting time, which show a linear relation with the level of dabigatran.
haemorrhages due to both metalloproteases and ecarin (an enzyme
ocellatus leads to inflammation (such as swelling, blistering and necrosis) and haemorrhages due to both metalloproteases and ecarin (an enzyme that activates prothrombin).
Thrombin time (TT) has been used for detecting the presence of dabigatran, but a modified version of TT; the dilute thrombin time (dTT) and chromogenic ecarin clotting time (ECT) have better correlation with serum concentration and would be helpful for quantitative detection of dabigatran and its clinical efficacy; however, there is limited use of this assay in most clinical scenarios, as tests await US FDA licensing [23].
The AHA/ASA guidelines do not recommend IVT for patients on warfarin with an INR > 1.7 and/or a PT > 15 seconds, patients who received a therapeutic dose of LMWH in the last 24 hours, or patients taking a direct thrombin inhibitor or a factor Xa inhibitor, unless coagulation tests (e.g., aPTT, INR, platelet count, ecarin clotting time, thrombin time, or appropriate direct factor Xa activity assays) are normal, or more than 48 hours have passed since the last dose (assuming normal renal function) [9].
The coagulation cascade is activated because of two metalloproteinases contained in the venom (ecarin and carinactivase) that promote prothrombin activity (5).
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].
Measuring dabigatran concentrations using a chromogenic ecarin clotting time assay.
Administering two consecutive doses of 2.5 g intravenously, as bolus or injection, will immediately yield complete reversal of this new oral anticoagulant as measured by dilute thrombin time or ecarin clotting time.
In the same study, 4F-PCC did not reverse elevated PTT, ecarin clotting time, and thrombin time in subjects receiving dabigatran, and it had no effect on endogenous thrombin potential.
El ECT (por las siglas de su nombre en ingles Ecarin Clotting Time) es una prueba de coagulacion basada en la activacion de la protrombina por accion de la ecarina, una enzima aislada del veneno de la serpiente Echis carinatus, generando meizotrombina, un precursor cataliticamente activo de la trombina capaz de transformar el fibrinogeno en fibrina (63).