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Master Thesis

AVC ischémique et AOD: gestion des dosages biologiques dans le cadre des téléthrombolyses en Nouvelle-Aquitaine

Abstract : Direct oral anticoagulants (DOACs) do not require systematic biological monitoring. However, to perform a thrombolysis in the context of an ischemic stroke, the dosage of their anticoagulant activity is essential: a DOAC concentration of less than 30 or 50 ng/mL (depending on the sources) is recommended. In Bordeaux University Hospital, neurologists are required to realize thrombolysis remotely (via a telemedicine device) for patients admitted in peripheral centers in the Nouvelle-Aquitaine Region, without often having specific dosages of DOACs. We therefore studied the correspondence of these assays with hemostasis tests available on site. For dabigatran, the thrombin time is interesting but is no longer available because it is not financially covered. For rivaroxaban and apixaban, we used the anti-Xa assay for UFH in 5 centers using 2 types of reagents: Liquid Anti-Xa HemosIL® Werfen (Bordeaux University Hospital, Exalab Laboratory for Blaye Hospital, Arcachon Hospital) and STA-Liquid Anti-Xa® Stago (Langon Hospital, Accolab Laboratory for Mutualist Clinic of Médoc). We found a very good correlation between anti-Xa activities for DOAC and UFH with a degree 3 polynomial model (R2>0,96). We established cut-offs of anti-Xa activity for UFH in IU/mL corresponding to decision thresholds of 30 and 50 ng/mL. In Bordeaux University Hospital, their sensitivity and specificity are very satisfactory (>96%). However, they could not be calculated in the peripheral centers, due to a lack of dosages around the decision thresholds. We also noted a very significant inter-reagent variability, with much higher cut-offs for the Stago reagent. These results are very promising. However, the proposed cut-offs will need to be verified by a complementary study including more dosages around the decision thresholds.
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Master Thesis
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Submitted on : Wednesday, November 4, 2020 - 3:52:17 PM
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Clémentine Leroux. AVC ischémique et AOD: gestion des dosages biologiques dans le cadre des téléthrombolyses en Nouvelle-Aquitaine. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02988244⟩



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