1
|
Liu Z, Mu G, Xie Q, Zhang H, Jiang J, Xiang Q, Cui Y. Hemoclot Thrombin Inhibitor Assay and Expected Peak-Trough Levels of Dabigatran: A Multicenter Study. Front Cardiovasc Med 2022; 9:894888. [PMID: 35935625 PMCID: PMC9353555 DOI: 10.3389/fcvm.2022.894888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Dabigatran concentrations monitoring are gaining importance of special situations, but limited data are available for the expected peak and trough levels. The hemoclot thrombin inhibitor (HTI) is dabigatran-calibrated quantitative determination of dabigatran concentration. This study aims to validate HTI assay as the quantification choice of dabigatran, and providing the expected peak and trough levels. Materials and Methods This is a multi-center methodology validate study, including seven hospitals from Beijing, Shanghai, Henan, Hunan, Chongqing, and Fujian. We retrospectively analyzed plasma samples taken from 118 healthy subjects and 183 patients receiving dabigatran. Dabigatran concentrations were measured with HTI assay and high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Linear regression, Spearman correlation and Bland-Altman analysis were used in this study. Results The mean concentration ratio of HPLC-MS/MS and HTI assays was 1.03 and 0.98 at 2 and 12 h, and the acceptance ranges for both the ratio limit as well as the limit of agreement were met, suggesting good agreement between the HTI-derived plasma concentrations and HPLC-MS/MS. The reference detection range of single dose dabigatran 150 mg in healthy subjects was 33–159 ng/ml. About 500 blood samples were taken from 183 patients suggested that the expected peak and trough levels range of dabigatran 110 mg was about 95–196 and 36–92 ng/ml. Conclusion Hemoclot thrombin inhibitor assay can be a good quantitative detection method of dabigatran. Expected peak and trough levels provide a basis for the rational use of dabigatran, and provide important Asian population data for the update of the international clinical guidelines for hematological testing. Clinical Trial Registration [https://clinicaltrials.gov], identifier [NCT03161496].
Collapse
Affiliation(s)
- Zhiyan Liu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Guangyan Mu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Qiufen Xie
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Hanxu Zhang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Qian Xiang,
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- Institute of Clinical Pharmacology, Peking University, Beijing, China
- *Correspondence: Yimin Cui,
| |
Collapse
|
2
|
Ng J, Mohd Tahir NA, Chin PKL, Makmor‐Bakry M, Mohd Saffian S. A systematic review and meta‐analysis of dabigatran peak and trough concentration in adults. Br J Clin Pharmacol 2022; 88:4443-4459. [DOI: 10.1111/bcp.15431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/30/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jia‐Wei Ng
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz Kuala Lumpur Malaysia
| | - Nor Asyikin Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz Kuala Lumpur Malaysia
| | - Paul K. L. Chin
- Department of Medicine University of Otago Christchurch New Zealand
- Department of Clinical Pharmacology, Christchurch Hospital Christchurch New Zealand
| | - Mohd Makmor‐Bakry
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz Kuala Lumpur Malaysia
| | - Shamin Mohd Saffian
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz Kuala Lumpur Malaysia
| |
Collapse
|
3
|
Shaikh K, Mungantiwar A, Halde S, Pandita N. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for determination of free and total dabigatran in human plasma and its application to a pharmacokinetic study. Drug Dev Ind Pharm 2022; 47:1835-1846. [PMID: 35452338 DOI: 10.1080/03639045.2022.2069257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A high performance liquid chromatography tandem mass spectrometric method for the determination of free and total dabigatran in human plasma has been developed and validated using stable labeled internal standard (IS) as dabigatran D4. The extraction of analyte and IS was accomplished by solid phase extraction technique. Chromatographic separations were achieved using Peerless basic C8 (150 x 4.6) mm, 5µ column eluted at flow rate of 1 mL/min with mobile phase Acetonitrile: 5 mM ammonium formate: Methanol and 0.2% formic acid (30:20:50, v/v/v). The run time of method was about 2.5 min with elution times of dabigatran and dabigatran D4 at around 1.2 min. The multiple reaction monitoring transitions (Q1/Q3) were set at 472/289, 172 (m/z) for dabigatran and 476/293 (m/z) for dabigatran D4. The calibration curves were linear (r2 ≥0.99) over the range of 1.04 - 406.49 ng/mL.The presented method was successfully employed in analysis of pharmacokinetic studies with an added advantage of demonstrating the effect of co-administration of dabigatran with the proton pump inhibitor pantoprazole on bioavailability and pharmacokinetic characteristics. Re-analysis of incurred sample resulted with >98% compliance indicating good assay precision of target analytes.Re-analysis of incurred sample resulted with >98% compliance which indicated good assay precision of target analytes.
Collapse
Affiliation(s)
- Khurshid Shaikh
- Department of Bioequivalence, Research & Development Centre, Macleods Pharmaceuticals Limited, Mumbai, India.,Department of Chemistry, Sunandan Divatia School of Science, NMIMS University, Mumbai, India
| | - Ashish Mungantiwar
- Department of Bioequivalence, Research & Development Centre, Macleods Pharmaceuticals Limited, Mumbai, India
| | - Supriya Halde
- Department of Bioequivalence, Research & Development Centre, Macleods Pharmaceuticals Limited, Mumbai, India
| | - Nancy Pandita
- Department of Chemistry, Sunandan Divatia School of Science, NMIMS University, Mumbai, India
| |
Collapse
|
4
|
Abd Allah FI, Ali Almrasy A, Abdelhmaid A, Abd-Elmegid OA, Alkashlan A, El-Attar AAMM. Development and Validation of UPLC-MS/MS Method for Quantifying of Free and Total Dabigatran in Human Plasma: An Application for a Bioequivalence Study. Biomed Chromatogr 2022; 36:e5382. [PMID: 35389511 DOI: 10.1002/bmc.5382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/11/2022]
Abstract
Dabigatran etexilate mesylate (DABE), a prodrug, quickly changes in our bodies after its oral administration into dabigatran (DAB). Accordingly, detecting DABE in plasma is practically unmanageable. A UPLC-MS/MS technique was developed and validated to compute free DAB in participants. For the first time, the central composite design- a type of response surface methodology- was utilized for optimizing variables affecting the cleavage of glucuronide bond. Additionally, the pharmacokinetic parameters of generic medication (okanadab) were determined, and the obtained outcomes were compared to those of branded drug (pradaxa®). The sample preparation was done using methanol as a protein precipitant and the separation was achieved via ACQUITY UPLC BEH C18 column (2.1x50mm, 1.7μm). The elution was isocratically conducted using 10mM ammonium formate: methanol (72:28, v/v) as a mobile phase (MP) and the flow rate was 0.25mL/min. Multiple reaction monitoring (MRM) and positive electrospray ionization (ESI) were used. The determination was performed within 1min, and the calibration growth curve was established over a range of (1.19 - 475) ng/mL using dabigatran-d3 as a tagged internal standard (IS). Bioequivalence research was validated following FDA guidelines for bio-analytical procedures and acceptable outcomes were achieved. The outcomes for okanadab and pradaxa® did not differ significantly.
Collapse
Affiliation(s)
- Fathy Ibrahim Abd Allah
- Department of Pharmaceutics, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt.,International Center for Bioavailability, Pharmaceutical, and Clinical Research
| | - Ahmed Ali Almrasy
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Al-Azhar University, Cairo11751, Egypt
| | - Ahmed Abdelhmaid
- International Center for Bioavailability, Pharmaceutical, and Clinical Research
| | - Osama A Abd-Elmegid
- International Center for Bioavailability, Pharmaceutical, and Clinical Research
| | - Akram Alkashlan
- International Center for Bioavailability, Pharmaceutical, and Clinical Research
| | - Abdul-Aziz M M El-Attar
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Al-Azhar University, Cairo11751, Egypt
| |
Collapse
|
5
|
Park IH, Park JW, Chung H, Kim JM, Lee S, Kim KA, Park JY. Development and validation of LC-MS/MS method for simultaneous determination of dabigatran etexilate and its active metabolites in human plasma, and its application in a pharmacokinetic study. J Pharm Biomed Anal 2021; 203:114220. [PMID: 34175734 DOI: 10.1016/j.jpba.2021.114220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 01/18/2023]
Abstract
Dabigatran is a direct thrombin inhibitor widely used for preventing various thrombotic events. Although there are several established LC-MS/MS based methods for quantification of plasma dabigatran etexilate and its active metabolites (dabigatran and dabigatran acylglucuronide), so far, there are no studies for simultaneous quantification of dabigatran etexilate, dabigatran, and dabigatran acylglucuronide in human plasma samples. In the present study, a novel and sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) method was developed and validated for assessment of dabigatran pharmacokinetics in human plasma samples according to FDA guidelines. We used the new method to simultaneously quantify dabigatran etexilate, dabigatran, and dabigatran acylglucuronide in human plasma samples. After deproteinization using acetonitrile, the supernatants were evaporated, dissolved in a mobile phase, and finally injected onto an HPLC system with a silica-based C18 reverse-phase column. Mass spectrometer system was operated in multiple reaction monitoring mode (MRM) (dabigatran etexilate: m/z 629.464→290.100; dabigatran: m/z 472.300→289.100, and dabigatran acylglucuronide: m/z 648.382→289.100) and all the components were confirmed using positive electrospray ionization (ESI). Correlation coefficients > 0.999 were achieved for all the calibration curves with linear regression. The intra-day and inter-day accuracies of dabigatran etexilate, dabigatran, and dabigatran acylglucuronide were 95.84-109.44 %, 99.4-103.42 %, and 98.37-104.42 %, respectively, while their corresponding precisions were 3.84-9.79, 1.07-8.76 %, and 2.56-4.51 %, respectively. We successfully applied the new method to determine the pharmacokinetic profiles of dabigatran etexilate, dabigatran, and dabigatran acylglucuronide in humans. Our findings demonstrated the method as robust, reliable, and sensitive.
Collapse
Affiliation(s)
- In-Hwan Park
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Jin-Woo Park
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea; Department of Neurology, Anam Hospital, Korea University Medical Center, Seoul, 02841, Republic of Korea.
| | - Hyewon Chung
- Department of Clinical Pharmacology and Toxicology, Guro Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Jong-Min Kim
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Sangjin Lee
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Kyoung-Ah Kim
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea
| | - Ji-Young Park
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, Seoul, 02841, Republic of Korea.
| |
Collapse
|
6
|
Lin SY, Peng YF, Huang CF, Kuo CH, Tang SC, Jeng JS. Measurement of Dabigatran Concentration Using Finger Prick Dried Blood Spot Sample Collection. Front Pharmacol 2021; 12:679431. [PMID: 34122105 PMCID: PMC8187780 DOI: 10.3389/fphar.2021.679431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/12/2021] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose: Real-world laboratory monitoring of dabigatran activity is challenging. The purpose of the present study was to demonstrate the feasibility and accuracy of finger prick sampling with dried blood spot (fpDBS) cards in measuring the dabigatran concentration. Material and Methods: Patients >20 years of age with atrial fibrillation and receiving dabigatran therapy for more than 7 days were included in the study. Peak and trough dabigatran concentrations were collected by simultaneous finger prick and venous puncture. The dabigatran concentration was measured by ultra-high performance liquid chromatography with tandem mass spectrometry. Our previously developed post-column infused internal standard (PCI-IS) method was applied to estimate the blood spot volume on fpDBS and to calibrate the drug concentration. Deming regression was used to analyze the correlation between dabigatran concentration on fpDBS cards and in plasma samples, followed by Bland–Altman analysis to compare the bias between two sampling techniques. Results: A total of 33 patients were enrolled and contributed 66 plasma and 55 fpDBS dabigatran samples. The average patient age was 74.6 ± 7.9 years, mean creatinine clearance 58.1 ± 18.3 mL/min, and CHA2DS2-VASc score 3.5 ± 1.6 points. The dabigatran concentration ranged from 41.8–1421.7 ng/mL. The plasma and DBS dabigatran concentrations correlated well (r = 0.98), and the conversion factor for fpDBS to plasma dabigatran concentration was 1.28. The Bland–Altman analysis showed that 94.5% of the fpDBS-predicted concentration fell within 20% of bias. Conclusions: The study showed that fpDBS measurement of dabigatran concentration is reliable and can be applied in clinical scenarios.
Collapse
Affiliation(s)
- Shin-Yi Lin
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Fong Peng
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Fen Huang
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Hua Kuo
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
7
|
Simultaneous Determination of Dabigatran, Rivaroxaban, and Apixaban in Human Plasma by Liquid Chromatography/Tandem Mass Spectrometry. Ther Drug Monit 2020; 42:473-480. [DOI: 10.1097/ftd.0000000000000744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Abstract
BACKGROUND A liquid chromatography-mass spectrometry assay to determine plasma dabigatran concentrations has been available for routine clinical use at our tertiary institutions since 2017. The aim of the study was to describe (1) the use of the assay over time; (2) the indications for testing; and (3) subsequent dabigatran prescribing decisions. METHODS Patients for whom dabigatran concentrations were measured were identified using the laboratory database, and clinical data were extracted from the associated electronic health records. RESULTS There were 233 samples in 24 months. The use of dabigatran increased over time, with a mean (95% confidence interval) increase of +0.5 (0.3-0.7) samples per month. Dabigatran concentrations ranged from <1 to 1060 mcg/L. The main reasons for testing were uncertainty about impact on renal function and drug interactions (39%), to inform prescribing decisions after thromboembolic or bleeding events (21%), and for investigation following dose-adjustment (16%). Dabigatran dose was changed after 30% (68/233) of assay results. CONCLUSIONS The clinical use of the dabigatran assay has increased, with almost one-third of results associated with a subsequent change in dabigatran prescribing.
Collapse
|
9
|
Liquid chromatographic methods for the determination of direct oral anticoagulant drugs in biological samples: A critical review. Anal Chim Acta 2019; 1076:18-31. [DOI: 10.1016/j.aca.2019.03.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 12/20/2022]
|
10
|
Brett OF, Brett CN, Chin PKL. The effect of routine preoperative interruption of dabigatran therapy on coagulation parameters and dabigatran plasma levels in a mixed surgical population. Anaesth Intensive Care 2019; 47:183-188. [DOI: 10.1177/0310057x19841009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Summary Dabigatran is an oral anticoagulant used for atrial fibrillation and venous thromboembolism. While an effective antibody reversal agent is available, its cost precludes routine use and the mainstay of preoperative management is timely dabigatran interruption. Unlike warfarin, there are no universally accepted protocols for interruption of dabigatran in the preoperative period and there is uncertainty around the interpretation of standard coagulation tests in the presence of dabigatran. We performed a prospective, observational pilot study in patients presenting for elective surgery to examine: 1) the preoperative plasma dabigatran concentrations on day of surgery associated with the local dabigatran interruption protocol, 2) the potential utility of dabigatran concentrations on day of surgery, and 3) the utility of standard coagulation tests in determining whether dabigatran concentrations were below a ‘safe’ threshold for surgery. We recruited patients presenting to pre-admission clinics for elective surgery. Dabigatran concentrations below 30 µg/L were considered adequate for proceeding with surgery. Data were obtained and analysed from 21 patients with a median (range) age of 70 (20–86) years. Median (range) dabigatran concentrations on the day of surgery were 5 (0–59) µg/L. Two patients had day of surgery concentrations exceeding 30 µg/L. Of the standard coagulation tests examined, only the thrombin clotting time (TCT) was abnormal for these two patients. Our interruption protocol was associated with safe dabigatran concentrations in most patients on the day of surgery. A minority of patients had dabigatran concentrations above the safe threshold, which were detectable by abnormal TCT results.
Collapse
Affiliation(s)
- Oliver F Brett
- Department of Anaesthesia, Canterbury District Health Board, Christchurch, New Zealand
| | - Christian N Brett
- Department of Anaesthesia, Canterbury District Health Board, Christchurch, New Zealand
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
| | - Paul KL Chin
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Department of Clinical Pharmacology, Canterbury District Health Board; Christchurch, New Zealand
| |
Collapse
|
11
|
Validation of an LC–MS/MS method for the simultaneous quantification of dabigatran, rivaroxaban and apixaban in human plasma. Bioanalysis 2016; 8:275-83. [DOI: 10.4155/bio.15.261] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Novel oral anticoagulants are characterized by a wide therapeutic window, yet the determination of their plasma–drug concentrations may be useful in some clinical conditions. Results: An LC–MS/MS method for the analysis of dabigatran, apixaban and rivaroxaban in human plasma has been successfully developed and validated. The analysis of plasma samples from patients given other concomitant drugs revealed no significant interference. By reanalysis of samples from patients on anticoagulant therapy, we found the percentage difference in results between the concentration of repeat and the original sample to be within the threshold limit of 20% in 60 of 63 specimens. Conclusion: The developed LC–MS/MS assay is easily applicable in the clinical management of patients on anticoagulation therapy.
Collapse
|