BJA Advance Access published September 13, 2016 British Journal of Anaesthesia, 2016, 1–9 doi: 10.1093/bja/aew259 Laboratory Investigation
L A B O R ATO RY I N V E S T I G AT I O N
B. Schenk1, *, P. Würtinger2, W. Streif3, W. Sturm4, D. Fries1 and M. Bachler1 1
Department of General and Surgical Intensive Care Medicine, 2Central Institute for Medical and Chemical Laboratory Diagnostics, 3Department of Paediatrics, and 4Department of Internal Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
*Corresponding author. E-mail:
[email protected]
Abstract Background: In major bleeding events, the new direct oral anticoagulants pose a great challenge for physicians. The aim of the study was to test for ex vivo reversal of the direct oral anticoagulant rivaroxaban with various non-specific reversal agents: prothrombin complex concentrate (PCC), activated prothrombin complex concentrate (aPCC), recombinant activated factor VII (rFVIIa), and fibrinogen concentrate (FI). Methods: Blood was obtained from healthy volunteers and from patients treated with rivaroxaban. Blood samples from healthy volunteers were spiked with rivaroxaban to test the correlation between rivaroxaban concentration and coagulation tests. Patient blood samples were spiked with various concentrations of the above-mentioned agents and analysed using thromboelastometry and thrombin generation. Results: When added in vitro, rivaroxaban was significantly (P
