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Table 1 Clinical and research tests available for the assessment of plasma dabigatran concentration

From: Efficacy of prothrombin complex concentrates for the emergency reversal of dabigatran-induced anticoagulation

Test Sensitivity to plasma dabigatran concentration Availability Clinical recommendation
Thrombin time Linear dose response; oversensitive Widely available Recommended for detection of presence or absence of dabigatran activity
Activated partial thromboplastin time (aPTT) Non-linear dose response Widely available Recommended for semi-quantitative estimation of dabigatran activity; normal aPTT does not always exclude presence of dabigatran
Direct thrombin inhibition assays Linear dose response; sensitive Usually available in specialised centres Recommended for measurement of plasma concentration; ECT usually a local assay because commercial kits not available; not validated for dabigatran
 Diluted thrombin time
 Ecarin clotting time (ECT)
Thromboelastometry (ROTEM®)/thrombelastography (TEG®) assays EXTEM/Rapid TEG Sensitive Limited availability Potential measurement of effectiveness of treatment for dabigatran-induced anticoagulation; not validated for dabigatran
Thrombin-generation assays Sensitive (lag time) Limited availability Potential measurement of effectiveness of treatment for dabigatran-induced anticoagulation; not validated for dabigatran
Prothrombin time or international normalised ratio Low sensitivity Widely available Not recommended in this setting