Effect of rivaroxaban, in contrast to heparin, is similar in neonatal and adult plasma

Novak, M. John; Schlagenhauf, Axel; Bernhard, Heike; Schweintzger, Sabrina; Leschnik, B.; Muntean, W.

doi:10.1097/mbc.0b013e328349f190

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…63 Significant reagent-dependent differences in assay sensitivity were noted in multiple studies. 40,48,[60][61][62][63]66,76,90 APTT: Seventeen studies 24,40,48,58,59,61,62,66,68,73,76,79,80,85,86,89,91 assessed the effect of rivaroxaban on APTT. A poor to moderate concentration-dependent prolongation of the APTT was noted.…”

Section: Rivaroxabanmentioning

confidence: 99%

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Laboratory Assessment of the Anticoagulant Activity of Direct Oral Anticoagulants

Samuelson

Cuker

Siegal

et al. 2017

Chest

261

253

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An ideal test, offering both accuracy and precision for measurement of any DOAC is not widely available. We recommend a dilute TT or ecarin-based assay for assessment of the anticoagulant effect of dabigatran and anti-Xa assays with drug-specific calibrators for direct Xa inhibitors. In the absence of these tests, TT or APTT is recommended over PT/INR for assessment of dabigatran, and PT/INR is recommended over APTT for detection of factor Xa inhibitors. Time since last dose, the presence or absence of drug interactions, and renal and hepatic function should impact clinical estimates of anticoagulant effect in a patient for whom laboratory test results are not available.

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Section: Rivaroxabanmentioning

confidence: 99%

“…A poor to moderate concentration-dependent prolongation of the APTT was noted. 48,61,62,68,73,76,80,81,85,89 APTT assay sensitivity was reagent dependent. 40,48,62,76,80,91 Variability within assays 40,80 and between laboratories (coefficient of variation, 14.3%-15.5%) 45,48,56,71,89 was also reported.…”

Section: Rivaroxabanmentioning

confidence: 99%

Laboratory Assessment of the Anticoagulant Activity of Direct Oral Anticoagulants

Samuelson

Cuker

Siegal

et al. 2017

Chest

261

253

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“…Off‐label use of DOACs in pediatrics is largely extrapolated from adult dosing guidelines. Preclinical data showed that rivaroxaban affects thrombin generation in umbilical cord blood at similar doses to those used in adults, suggesting that dosing may be both feasible and simpler in neonates than dosing with UFH. There are many clinical trials currently recruiting pediatric patients and are under way to assess their effects and efficacy in this special population …”

Section: Treatment Of Hitmentioning

confidence: 99%

Heparin‐induced thrombocytopenia complicating extracorporeal membrane oxygenation support: Review of the literature and alternative anticoagulants

Pollak

2019

Journal of Thrombosis and Haemostasis

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Heparin‐induced thrombocytopenia (HIT) is a life‐threatening prothrombotic, immune‐mediated complication of unfractionated heparin and low molecular weight heparin therapy. HIT is characterized by moderate thrombocytopenia 5‐10 days after initial heparin exposure, detection of platelet‐activating anti‐platelet factor 4/heparin antibodies and an increased risk of venous and arterial thrombosis. Extracorporeal membrane oxygenation (ECMO) is a form of mechanical circulatory support used in critically ill patients with respiratory or cardiac failure. Systemic anticoagulation is used to alleviate the thrombotic complications that may occur when blood is exposed to artificial surfaces within the ECMO circuit. Therefore, when HIT complicates patients on ECMO support, it is associated with a high thrombotic morbidity and mortality. The risk for HIT correlates with the accumulative dosage of heparin exposure. In ECMO patients receiving continuous infusion of heparin for circuit patency, the risk for HIT is not neglected and must be thought of in the differential diagnosis of the appropriate clinical and laboratory circumstances. The following article reviews the current knowledge in HIT complicating ECMO patients and the alternative anticoagulation options in the presence of HIT.

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“…The DOACs, such dabigatran, rivaroxaban, apixaban, or edoxaban, are currently not registered in Europe or in the United States for pediatric patients. However, some off‐label studies were published . However, as too few data were published, no recommendations or even suggestions are available so far, even though there is an increasing need for new anticoagulation options in pediatric populations.…”

Section: Discussionmentioning

confidence: 99%

Developmental hemostasis: laboratory and clinical implications

Toulon

2016

Int J Lab Hematology

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Summary The pediatric hemostatic balance, which is different from that in adults, is an evolving process as the hemostatic system changes and matures throughout the time from fetal to adult life, particularly in the first months of life. The concept of developmental hemostasis was confirmed by several studies evaluating different patients’ population in various technical conditions. All these studies demonstrated that, at birth, the plasma levels of most coagulation factors were around half that found in adults, the preterm newborns having lower levels than full‐term newborns. Adult values were usually reached between a few months of age and up to above 16 years for specific parameters. If the global trends are consistent across the studies, differences in absolute values could be demonstrated that are likely due to differences in the reagents and/or the instruments used. Accordingly, it is recommended by the Perinatal and Pediatric Haemostasis Subcommittee of the Scientific and Standardization Committee of the ISTH for each laboratory to define the age‐dependent reference ranges using its own technical condition. The understanding of that concept of developmental hemostasis, which is now universally accepted, is critical to ensure optimal prevention, diagnosis, and treatment of thrombotic and hemorrhagic diseases in children. Actually, developmental hemostasis could affect the interaction between anticoagulant drugs and the coagulation system and so explain in part the discrepancy between anticoagulation in adults and in children. Finally, developmental hemostasis could probably provide a protective mechanism for neonates and children, contributing to the decreased risk of thrombosis and/or bleeding in these age‐groups.

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Effect of rivaroxaban, in contrast to heparin, is similar in neonatal and adult plasma

Cited by 10 publications

References 23 publications

Laboratory Assessment of the Anticoagulant Activity of Direct Oral Anticoagulants

Laboratory Assessment of the Anticoagulant Activity of Direct Oral Anticoagulants

Heparin‐induced thrombocytopenia complicating extracorporeal membrane oxygenation support: Review of the literature and alternative anticoagulants

Developmental hemostasis: laboratory and clinical implications

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