Technique Articles

Microfluidic Point-of-Care Ecarin-Based Clotting and Chromogenic Assays for Monitoring Direct Thrombin Inhibitors

^* Department of Pharmacology, Perfusion Sciences Program, College of Medicine, The University of Arizona, Tucson, Arizona; and
^† Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona

Address correspondence to: Jeong-Yeol Yoon, PhD, Department of Biomedical Engineering, The University of Arizona, 1127 E. James E. Rogers Way, Tucson, AZ 85721-0020, E-mail: jyyoon@email.arizona.edu or Raymond K. Wong, PhD, CCP, Department of Pharmacology, Perfusion Science Program, College of Medicine, The University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724-5050, E-mail: rkwong@email.arizona.edu.

Received: 27 June 2018
Accepted: 17 January 2019

Abstract

Direct thrombin inhibitors (DTIs), such as bivalirudin and dabigatran, have maintained steady inpatient and outpatient use as substitutes for heparin and warfarin, respectively, because of their high bioavailability and relatively safe “on-therapy” range. Current clinical methods lack the capacity to directly quantify plasma DTI concentrations across wide ranges. At present, the gold standard is the ecarin clotting time (ECT), where ecarin maximizes thrombin activity and clotting time is evaluated to assess DTIs’ anticoagulation capability. This work focused on the development of a microfluidic paper analytic device (µPAD) that can quantify the extent of anticoagulation as well as DTI concentration within a patient’s whole blood sample. Capillary action propels a small blood sample to flow through the nitrocellulose paper channels. Digital images of whole blood migration are then captured by our self-coded Raspberry Pi and/or the Samsung Galaxy S8 smartphone camera. Both the flow length and the blue absorbance from the plasma front on the μPAD were measured, allowing simultaneous, dual assays: ecarin clotting test (ECT) and ecarin chromogenic assay (ECA). Statistically significant (p < .05) changes in flow and absorbance were observed within our translational research study. Currently, there are no quantitative, commercially available point-of-care tests for the ECT and ECA within the United States. Both the ECT and ECA assays could be instrumental to differentiate between supratherapeutic and subtherapeutic incidents during bridging anticoagulant therapy and limit the unwarranted use of reversal agents.