Comparison of the effects of apixaban and rivaroxaban on prothrombin and activated partial thromboplastin times using various reagents. (12th October 2014)

• Record Type: Journal Article
• Authors: Dale, B. J.; Ginsberg, J. S.; Johnston, M.; Hirsh, J.; Weitz, J. I.; Eikelboom, J. W.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 12:Number 11(2014:Nov.)
• Page Start: 1810
• Page End: 1815
• Publication Date: 2014-10-12
• Subjects: Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.12720
• Languages: English
• ISSNs: 1538-7933

Abstract

<abstract abstract-type="main" id="jth12720-abs-0001"> <title>Summary</title> <sec id="jth12720-sec-0001" sec-type="section"> <title>Background</title> <p>Clinical situations occur where expedient assessment of the anticoagulant activity of the direct factor Xa (FXa) inhibitors is required. Although quantitative anti‐FXa (FXa) assays can be used to measure plasma levels of apixaban or rivaroxaban, turnaround is often slow and many laboratories do not perform these assays.</p> </sec> <sec id="jth12720-sec-0002" sec-type="section"> <title>Objective</title> <p>We compared the <italic>in vitro</italic> effects of apixaban and rivaroxaban on two readily available laboratory tests, the prothrombin time (PT) and activated partial thromboplastin time (APTT), performed with different reagents. We aimed to identify the most sensitive reagents.</p> </sec> <sec id="jth12720-sec-0003" sec-type="section"> <title>Methods</title> <p>Rivaroxaban or apixaban was added to human plasma at a range of concentrations covering expected peak and trough levels, and concentrations were confirmed using calibrated anti‐FXa assays. Samples were assayed with six PT and seven APTT reagents using different coagulometers.</p> </sec> <sec id="jth12720-sec-0004" sec-type="section"> <title>Results and Conclusions</title> <p>TriniCLOT PT Excel S was the only reagent to demonstrate sensitivity to apixaban. All of the PT reagents were sensitive to rivaroxaban with TriniCLOT PT Excel S and HemosIL HS PLUS being the most sensitive. Sensitivity to rivaroxaban varied among APTT reagents; four reagents exhibited the greatest responsiveness, and of these, Actin FSL was the most responsive. Commonly used coagulation tests may be useful for assessing the anticoagulant effect of rivaroxaban but not of apixaban. The reason for the different effects of apixaban and rivaroxaban on the PT and APTT is unknown.</p> </sec> </abstract>