Dabigatran Plasma Measurement to Guide the Management of Acute Bleeding and Thrombotic Complications
  • Maurizio Tala
    Haemostasis and Thrombosis Center, ASST Cremona, Cremona, Italy
  • Oriana Paoletti
    Haemostasis and Thrombosis Center, ASST Cremona, Cremona, Italy
  • Claudia Dellanoce
    Haemostasis and Thrombosis Center, ASST Cremona, Cremona, Italy
  • Rossella Morandini
    Haemostasis and Thrombosis Center, ASST Cremona, Cremona, Italy
  • Carlo Valtulina
    Division of Neurosurgery, ASST Cremona, Cremona, Italy
  • Maria Sessa
    Division of Neurology, ASST Cremona, Cremona, Italy
  • Sophie Testa
    Haemostasis and Thrombosis Center, ASST Cremona, Cremona, Italy


DOACs, dabigatran, anticoagulant, plasma measurement, idarucizumab


Oral anticoagulant therapy is recommended for the prevention and treatment of venous thromboembolism and to prevent stroke in non-valvular atrial fibrillation. Until a few years ago, vitamin K antagonists were the only drugs available, but direct oral anticoagulants have recently been introduced into clinical practice for the same clinical indications. Unlike the situation with VKAs, fixed-dose administration was proposed for DOACs, without the necessity for routine laboratory monitoring. However, in clinical practice a high inter-variability in DOAC plasma levels, independently of the type of drug and patient characteristics, was observed and the importance of measuring DOAC anticoagulant activity to support treatment decisions has therefore been recognized. We describe two clinical cases in order to highlight the role and importance of dabigatran-specific measurements to guide patient management in case of major complications.



  • Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. >Chest 2012;141:e44S–e88S.

  • Testa S, Tripodi A, Legnani C, Pengo V, Abbate R, Dellanoce C, et al.; START-Laboratory Register. Plasma levels of direct oral anticoagulants in real life patients with atrial fibrillation: results observed in four anticoagulation clinics. Thromb Res 2016;137:178–183.

  • Tripodi A, Ageno W, Ciaccio M, Legnani C, Lippi G, Manotti C, et al. Position paper on laboratory testing for patients on direct oral anticoagulants. A consensus document from the SISET, FCSA, SIBioC and SIPMeL. Blood Transfus 2017:1–9.

  • Pollack CV Jr, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, et al. Idarucizumab for dabigatran reversal. N Engl J Med 2015;373:511–520.

  • Stangier J, Feuring M. Using the HEMOCLOT direct thrombin inhibitor assay to determine plasma concentrations of dabigatran. Blood Coagul Fibrinolysis 2012;23:138–143.

  • Testa S, Ageno W, Antonucci E, Morandini R, Beyer-Westendorf J, Paciaroni M, et al. Management of major bleeding and outcomes in patients treated with direct oral anticoagulants: results from the START-Event registry. Intern Emerg Med 018 May 22. doi:10.1007/s11739-018-1877-z [Epub ahead of print].

  • Cappellari M, Bovi P. Intravenous thrombolysis for stroke in patients taking non-VKA oral anticoagulants: an update. Thromb Haemost 2015;114:440–444.

  • Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al; American Heart Association Stroke Council. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018;49:e46–e110. Erratum in: Stroke 2018;49:e138.

  • Ahmed N, Steiner T, Caso V, Wahlgren N; ESO-KSU session participants. Recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 13–15 November 2016. Eur Stroke J 2017;2:95–102.

  • Seiffge DJ, Kägi G, Michel P, Fischer U, Béjot Y, Wegener S, et al; Novel Oral Anticoagulants in Stroke Patients study group. Rivaroxaban plasma levels in acute ischemic stroke and intracerebral hemorrhage. Ann Neurol 2018;83:451–459.
  • Views: 1295
    HTML downloads: 110
    PDF downloads: 385

    Published: 2018-09-06
    Issue: Vol 5 No 9 (view)

    How to cite:
    Tala M, Paoletti O, Dellanoce C, Morandini R, Valtulina C, Sessa M, Testa S. Dabigatran Plasma Measurement to Guide the Management of Acute Bleeding and Thrombotic Complications. EJCRIM 2018;5 doi:10.12890/2018_000947.

    Similar Articles

    You may also start an advanced similarity search for this article.

    Most read articles by the same author(s)