When things have to move fast: New blood coagulation test helps in emergencies

A new generation of anticoagulants, the so-called DOACs (short for Direct Oral Anti-Coagulants), effectively protect patients from dangerous blood clots and thromboses. However, this protection can quickly turn into the opposite if an accident happens. If bleeding occurs, the body can no longer stop it. This poses great challenges for both patients and medical staff in accident care. DOACs are enjoying great popularity and are being prescribed more and more often. In order to detect the coagulation disorders triggered by DOACs as quickly as possible, researchers at AUVA have tested the use of a new analytical method. The venom of the chain viper plays an important role in this.

When a patient with severe injuries is admitted to the shock room, everything has to happen quickly. The patient has to be stabilised, the bleeding has to be stopped and sometimes life-saving surgical interventions have to be performed on the spot. There is not much time for questions – if the patient is unconscious, this is not possible at all. One of the most important questions to ask is about the patient’s medical history and the medication they are taking. Because these can determine how the body behaves in an emergency.

Anticoagulants are particularly problematic in the treatment of seriously injured patients.

The problem is not new. Even the classic anticoagulants meant that bleeding was difficult to stop in emergencies. In the course of time, however, tests were developed that could be used to determine relatively quickly whether the patient had taken such drugs. No such rapid tests are yet in use for the new anticoagulants. Although it is possible to carry out special tests in the hospital’s central laboratory to determine individual drugs, these require the plasma to be separated from the blood and often incur high costs. Research into faster methods is in full swing. Recently, a device was introduced that has been shown to be effective in laboratory tests for detecting clotting disorders caused by DOACs. The test procedure is based on the so-called thromboelastometry and was developed by the company ClotPro®. It is based on a method that is already used in the diagnosis of the autoimmune disease lupus, the so-called RVV test.

RVV stands for Russel Viper Venom. The chain viper is considered one of the most dangerous snakes in Southeast Asia. Its venom contains enzymes that, among other things, activate blood clotting factor 10, thus triggering clotting. The victim’s blood literally freezes in his veins. DOACs also target factor 10. They intervene directly in the coagulation cascade and prevent the activation of factor 10 – in other words, they are the antagonist of the viper venom.

The device with RVV test has not yet been approved for clinical routine, but initial results are promising. An AUVA research group led by Herbert Schöchl (UKH Salzburg) and Johannes Zipperle (Ludwig Boltzmann Institute, AUVA Research Institute for Traumatology) has now been able to prove for the first time worldwide that it is well suited for use on patients and provides reliable results. The study was recently published in the renowned journal “Anesthesia”.

An extract of the poison was deliberately added to the blood samples of accident patients outside the body and it was observed whether the blood stagnated. A statement could be made after just a few minutes – not after more than an hour, as was previously the case. With the RVV test, there is no need to go to the laboratory and separate the blood plasma; it can be performed on whole blood, i.e. directly next to the patient in the shock room. This enabled the intensive care doctors to make important decisions quickly about the further treatment of the patients.

The study is the first of many that will be needed to enable the procedure to make the leap into everyday clinical practice. AUVA, which has already been able to provide groundbreaking research on coagulation disorders in the past, is once again at the forefront of a new development here.