Comparison of Anti-Xa Activity in Patients Receiving Apixaban or Rivaroxaban

Bookstaver, David A.; Sparks, Kimberly S.; Pybus, Brandon; Davis, Dustin K.; Marcsisin, Sean R.; Sousa, Jason

doi:10.1177/1060028017738262

Cited by 16 publications

(15 citation statements)

References 28 publications

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“…The institutional anti‐Xa used was a chromogenic assay (Diagnostica Stago S.A.S, Asniere sur Seine, France) with a hybrid validation curve for unfractionated heparin (UFH) and LMWH. The institution did not have FXa‐I‐specific assays available and the qualitative threshold of 0.5 units/ml was provided as institutional guidance based on prior literature 19–21 . The assay upper limit of detection was 1.8 units/ml while the lower limit was <0.1 units/ml.…”

Section: Methodsmentioning

confidence: 99%

Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures

et al. 2022

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Background: Outcomes following andexanet alfa reversal of factor Xa inhibitors in patients requiring urgent or emergent invasive procedures are lacking. This study aimed to describe efficacy and safety outcomes following andexanet alfa administration within 24 h of an invasive procedure.Methods: This single-center, observational, retrospective study included patients who received andexanet alfa within 24 h of an invasive or surgical procedure. The primary outcome was hemostatic efficacy graded as excellent, good, or poor using similar definitions to the ANNEXA-4 criteria. Secondary outcomes included hospital discharge disposition, intensive care unit (ICU) and hospital length of stay, 30-day mortality, 30-day thromboischemic event rates, and serum coagulation assay changes pre-and postreversal.Results: Forty-four patients met inclusion criteria; of these, 27 (62.8%) received apixaban and 16 (37.2%) were treated with rivaroxaban prior to admission. The indications for reversal were categorized as intracranial (n = 20 [45.5%]) or extracranial (n = 24 [54.5%]) sites. Majority of patients required emergent operative procedures (18 [40.9%]), followed by invasive device placement (10 [22.7%]) or arterial embolization (9 [20.5%]). Thirty-eight (86.4%) patients were able to be adequately graded for hemostatic efficacy. Overall, 30 (78.9%) patients achieved excellent or good hemostasis within 24 h after periprocedural administration of andexanet alfa ( 19[82.6%] apixaban vs. 11 [78.6%] rivaroxaban; 12 [80.0%] intracranial events vs. 18 [78.3%] extracranial events). Discharge disposition was most often to a short-or long-term care facilities (27 [61.4%]). Thirty-day mortality and thromboischemic complications occurred in 15 (34.1%) and 12 (27.3%) patients, respectively. Prothrombin time and | 781 BRADSHAW et al.

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Section: Methodsmentioning

confidence: 99%

Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures

et al. 2022

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“…While liquid chromatography‐tandem mass spectrometry (LC‐MS/MS) is considered the gold standard for DOAC quantification, 22 it less likely to be available within on‐site hospital laboratories for monitoring patients. The anti‐Xa chromogenic assay, 3,23 which is commonly available in clinical laboratories and utilized within this study, has been shown to correlate to LC‐MS/MS 31 . Further correlations of the anti‐Xa assay calibrated for apixaban (ng/ml) versus heparin (IU) are presented in Figure S1.…”

Section: Discussionmentioning

confidence: 97%

“…12 The predicted peak and trough concentrations at steady state associated with <400 mg amiodarone 12 The anti-Xa chromogenic assay, 3,23 which is commonly available in clinical laboratories and utilized within this study, has been shown to correlate to LC-MS/MS. 31 Further correlations of the anti-Xa assay calibrated for apixaban (ng/ml) versus heparin (IU) are presented in to increased bleeding events. 67 While this study was designed to investigate DDIs within our patient population, the small sample sizes for each cohort limited the ability to delve into the impact of dose response for the P-gp and CYP3A4 inhibitors and precluded statistically significant differences.…”

Section: Discussionmentioning

confidence: 99%

“…The anti‐Xa chromogenic assay, 3 , 23 which is commonly available in clinical laboratories and utilized within this study, has been shown to correlate to LC‐MS/MS. 31 Further correlations of the anti‐Xa assay calibrated for apixaban (ng/ml) versus heparin (IU) are presented in Figure S1 . In addition to therapeutic monitoring, clinicians should consider reviewing the co‐medication of patients administered apixaban to identify P‐gp and CYP3A4 inhibitors which reportedly lead to increased bleeding events.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Anti‐Xa activity in patients receiving concomitant apixaban with strong p‐glycoprotein inhibitors and statins

Milner

Ainsworth

Gleaton

et al. 2022

Clinical Pharmacy Therapeu

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What is known and objectives: Although the apixaban Food and Drug Administration (FDA) package insert recommends dose reduction in patients administered dual strong inhibitors of p-glycoprotein (P-gp) and cytochrome P-450 (CYP) 3A4, there are limited published data regarding potential drug-drug interactions between apixaban (Eliquis) and common p-glycoprotein (P-gp) and CYP3A4 inhibitors co-administered with statins. The aim of this study was to investigate the degree of elevation relative to apixaban serum peak and trough concentration after the co-administration of amiodarone, diltiazem and statins (atorvastatin, rosuvastatin and simvastatin).Methods: Patients prescribed apixaban 5mg twice daily for at least one week were identified from the anticoagulation clinic database and contacted for potential enrolment. A total of 117 volunteers were enrolled with eight excluded due to discontinued use, resulting in 109 volunteers (44 females and 65 males delineated into age groups 40-64 and ≥65 years old) completing the observational study. Fifty-five volunteers were administered apixaban without the P-gp inhibitors amiodarone or diltiazem, with or without statins (atorvastatin, rosuvastatin and simvastatin). Fifty-four volunteers were administered apixaban with either amiodarone or diltiazem, with or without statins (atorvastatin, rosuvastatin or simvastatin). Peak and trough concentrations were assessed for each patient utilizing an apixaban anti-Xa assay.Results: Of the combinations studied, the mean apixaban trough concentration upon co-administration of amiodarone without a statin was elevated compared to apixaban alone (experimental 156.83 +/− 79.59 ng/ml vs. control 104.09 +/− 44.56 ng/ ml; p = 0.04). The co-administration of diltiazem and rosuvastatin, and the administration of amiodarone without a statin led to greater than 1.5-fold increase in apixaban concentrations (peak experimental 315.19 +/− 157.53 ng/ml vs control 207.6 +/− 83.38 ng/ml; p = 0.08 and trough experimental 182.03 +/− 95.93 ng/ml vs control 112.32 +/− 37.78 ng/ml; p = 0.17) suggesting the need to assess dose adjustment for patients per the FDA package insert. In addition, the aggregated mean peak | 669 MILNER Et aL.

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“…Â äðóãîì ñëó÷àå àâòîðû ìåòîäèêè [12] ïðåäëàãàþò èñïîëüçîâàíèå ïðîáîïîäãîòîâêè, ïðåäïîëàãàþùåé äîïîëíèòåëüíîå ðàçáàâëåíèå îáðàçöà â 4 ðàçà, ÷òî ñíèaeàåò ÷óâñòâèòåëüíîñòü îïðåäåëåíèÿ. Â ðàáîòå [13] äèàïàçîí îïðåäåëÿåìûõ êîíöåíòðàöèé ðèâàðîêñàáàíà ñîñòàâëÿåò 2 -500 íã/ìë, ÷òî ìîaeåò îêàçàòüñÿ íåäîñòàòî÷íûì ïðè ïðîâåäåíèè ÒËÌ. Àâòîðàìè ïðåäëîaeåíà ïðîñòàÿ è áûñòðàÿ àíàëè-òè÷åñêàÿ ìåòîäèêà (âðåìÿ àíàëèçà 3 ìèí), ÷òî äîñòèãàåòñÿ áëàãîäàðÿ èçîêðàòè÷åñêîìó ýëþèðîâàíèþ.…”

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Разработка Методики Количественного Определения Ривароксабана В Сыворотке Крови Человека Методом Вэжх-Мс/Мс

Родина¹,

Мельников²,

Аксенов³

et al. 2018

Хим.-фарм. ж.

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Разработана методика определения ривароксабана в сыворотке крови человека с использованием метода ВЭЖХ-МС/МС. Пробоподготовка образцов проводилась осаждением белков метанолом с последующим центрифугированием и разбавлением пробы деионизированной водой. Разработанную методику отличает простота выполнения пробоподготовки, короткое время анализа и широкий аналитический диапазон (от 1,00 до 1000,00 нг/мл). Данная методика удобна при проведении рутинных биоаналитических исследований, в частности, для осуществления терапевтического лекарственного мониторинга.

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Comparison of Anti-Xa Activity in Patients Receiving Apixaban or Rivaroxaban

Abstract: Good correlation was shown between anti-Xa activity and serum levels. The clinical utility of monitoring anti-Xa activity and the significance of the difference in trough anti-Xa activity for these agents remains to be established.

Cited by 16 publications

References 28 publications

Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures

Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures

Assessment of Anti‐Xa activity in patients receiving concomitant apixaban with strong p‐glycoprotein inhibitors and statins

Разработка Методики Количественного Определения Ривароксабана В Сыворотке Крови Человека Методом Вэжх-Мс/Мс

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