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. 2022 Feb;44(1):163-167.
doi: 10.1111/ijlh.13692. Epub 2021 Sep 15.

Using a low-molecular weight heparin-calibrated anti-factor Xa assay to assess the concentration of apixaban and rivaroxaban

Henrik von Horn  1 , Agnes Rasmusson  1 , Lisbeth Söderblom  1 , Rickard E Malmström  2 , Jovan Antovic  1
Affiliations

Using a low-molecular weight heparin-calibrated anti-factor Xa assay to assess the concentration of apixaban and rivaroxaban

Henrik von Horn et al. Int J Lab Hematol. 2022 Feb.

Abstract

Introduction: Direct oral anticoagulant (DOAC)-inhibiting factor Xa (FXa-DOAC) are being increasingly used as prophylaxis of venous thromboembolism and for prevention of stroke in patients with atrial fibrillation. In contrast to vitamin K antagonists, DOACs do not require monitoring in general. However, it is sometimes of value in the acute setting, for instance when considering a reversal agent in uncontrolled bleeding in patients on DOAC.

Methods: We evaluated if a low-molecular weight heparin (LMWH)-calibrated anti-factor Xa assay could be used to estimate FXa-DOAC concentration in the concentration range <100 ng/mL by spiking known concentrations of FXa-DOAC and from those result calculate the FXa-DOAC concentration from the response of the LMWH assay. This procedure was then evaluated by comparing the result with a drug-calibrated chromogenic assay and liquid chromatography tandem mass spectrometry (LC-MS/MS) on clinical plasma samples from patients treated with apixaban or rivaroxaban.

Results: Although the measuring range was narrower for the LMWH-calibrated assay, concentrations recalculated from the LMWH assay was comparable with those measured by the drug-calibrated method when compared with LC-MS/MS.

Conclusion: We suggest that an LMWH-calibrated anti-factor Xa assay can be used after characterization of the response of FXa-DOACs to give guidance on the concentration of apixaban and rivaroxaban. Shorter turnaround time than LC-MS/MS and the greater availability than drug-calibrated chromogenic assays could make this a valuable option in the acute setting.

Keywords: DOAC; LC-MS/MS; LMWH; apixaban; chromogenic assay; factor Xa inhibitors; rivaroxaban.

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References

REFERENCES

    1. Eikelboom JW, Quinlan DJ, Hirsh J, Connolly SJ, Weitz JI. Laboratory monitoring of non-vitamin K antagonist oral anticoagulant use in patients with atrial fibrillation: a review. JAMA Cardiol. 2017;2(5):566-574.
    1. Kitchen S, Gray E, Mackie I, Baglin T, Makris M, committee B. Measurement of non-coumarin anticoagulants and their effects on tests of Haemostasis: Guidance from the British Committee for Standards in Haematology. Br J Haematol. 2014;166(6):830-841.
    1. Seiffge DJ, Traenka C, Polymeris AA, et al. Intravenous Thrombolysis in patients with stroke taking rivaroxaban using drug specific plasma levels: experience with a standard operation procedure in clinical practice. J Stroke. 2017;19(3):347-355.
    1. Christensen H, Cordonnier C, Korv J, et al. European stroke organisation guideline on reversal of oral anticoagulants in acute intracerebral haemorrhage. Eur Stroke J. 2019;4(4):294-306.
    1. Douxfils J, Adcock DM, Bates SM, et al. 2021 Update of the international council for standardization in haematology recommendations for laboratory measurement of direct oral anticoagulants. Thromb Haemost. 2021;121(08):1008-1020.

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