Direct Thombin Inhibitor measurement: argatroban and dabigatran

Description: 
Clotting based diluted thrombin time assay for the measurement of argatroban or dabigatran concentration in patient plasma. Routinely there is little or no requirement for laboratory testing due to predictable pharmacokinetics. However in situations such as pre-surgery, the presence of interfering drugs, impaired renal function, questions of compliance, bleeding or drug overdose monitoring may be indicated.
Clinical details: 
Direct Thrombin inhibitors (DTI) are anticoagulants used in the prevention and treatment of thromboembolic disorders including venous thromboembolism (VTE), prevention of thrombotic complications associated with heparin-induced thrombocytopenia (HIT); acute coronary syndromes (ACS); secondary prevention of coronary events after ACS and prevention of stroke in patients with non–valvular atrial fibrillation. Among the direct thrombin inhibitors in current clinical use are the oral DTI dabigatran (Pradaxa®) and the parenterally administered argatroban (Exembol®).
Related condition or disease: 
Therapeutic anticoagulation
Reference range: 

Dabigatran150mg bid: peak levels should be <275ng/ml. Please contact the laboratory for argatoban therapeutic range.

Synonyms or keywords: 
Direct Thrombin inhibitor (DTI). Dabigatran (Pradaxa®) and Argatroban (Exembol®)
Units: 
ng/mL
Department: 
Haemostasis and Thrombosis Department
Location: 
St Thomas' Hospital
Sample type and Volume required: 
External requests: Citrated platelet poor plasma 500µL x 1 aliquot Internal requests: please refer to EPR label
Turnaround time: 
5 - 7 days : Call laboratory to arrange urgent analysis
Special sample instructions: 

The sample should be analysed or stored within 4 hours of venepuncture. Please ensure sample tubes are filled exactly to the fill-line as underfilling or overfilling creates a dilution error and leads to inaccurate results.

Criteria for acceptance / rejections of sample
Storage and transport: 
It is advised that citrated plasma is frozen prior to transport and sent to the laboratory on dry ice to maintain sample quality and integrity.
Contacts:
Diagnostic Haemostasis and Thrombosis Department
St Thomas': 020 7188 2797; Guy's: 020 7188 7188 ext. 53860
St Thomas' Hospital
North Wing - 4th and 5th Floors
Westminster Bridge Road
London SE1 7EH

Laboratory opening times
24/7

Guy's Hospital
Southwark Wing - 4th Floor
Great Maze Pond
London SE1 9RT

Outside core hours, contact Duty Haemostasis Biomedical Scientist
For clinical advice or interpretation of results, please contact the laboratory in the first instance.
Laboratory: 
Diagnostic Haemostasis and Thrombosis Laboratory at Guy's and St Thomas'

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Last updated: 09/07/2021