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Effects of the oral, direct factor Xa inhibitor apixaban on routine coagulation assays and anti-Xa assays.
MedLine Citation:
PMID:  24965851     Owner:  NLM     Status:  Publisher    
INTRODUCTION: Apixaban is an oral direct factor Xa inhibitor developed for prophylaxis and treatment of thromboembolic disorders. Laboratory monitoring is not necessary, but the effects on common coagulation reagents and assays are clinically valuable information.
OBJECTIVES: To investigate the effect of apixaban on commonly used coagulation methods and evaluate anti-Xa assays for specific determination of the drug concentration.
MATERIAL AND METHODS: Apixaban was added to plasma from healthy subjects in the concentration range 0 -1,000 μg/L and analyzed using different reagents for activated partial thromboplastin time (APTT), prothrombin time (PT), antithrombin, protein C, and protein S. A lupus anticoagulant assay and an APTT with varying phospholipid concentrations were used to study the phospholipid dependence.
RESULTS: In general, apixaban displayed fewer effects in vitro than what has been shown for rivaroxaban, another direct Xa inhibitor. The concentration needed to double the APTT varied between 2,200 and 4,700 μg/L and between 700 and 3,900 μg/L for PT reagents. The effect on antithrombin, protein C and S assays was dependent on the type of reagent. Apixaban did not cause false positive lupus anticoagulant results. Chromogenic anti-Xa assays displayed linear dose-response curves with apixaban.
CONCLUSIONS: Therapeutic concentrations of apixaban variably affect different assay groups, and even different reagents within an assay group. The effects were much smaller compared with rivaroxaban. Use of APTT and/or PT assays to screen the anticoagulant activity of apixaban cannot be recommended. Chromogenic anti-Xa assay can be deployed for reliable measurements of apixaban concentration. This article is protected by copyright. All rights reserved.
Andreas Hillarp; Kerstin M Gustafsson; Lars Faxälv; Karin Strandberg; Fariba Baghaei; Inger Fagerberg Blixter; Maria Berndtsson; Tomas L Lindahl
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-25
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  -     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-6-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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