Feasibility of rapid measurement of Rivaroxaban plasma levels in patients with acute stroke

Abstract

Plasma levels of Rivaroxaban (RivLev) might be useful to guide therapeutic decisions in patients with acute stroke under Rivaroxaban. A prerequisite for the potential clinical usefulness is their rapid availability in emergency situations. Single-center explorative analysis from the Novel-Oral-Anticoagulants-in-Stroke-Patients-registry (NOACISP, cinicaltrials.gov:NCT02353585). We included consecutive patients with acute ischemic or hemorrhagic stroke under Rivaroxaban (last intake <48 h) in which RivLev determined by an automated anti-factor Xa-based chromogenic assay (Hyphen-Biomed, France) are available. Primary endpoint was the turnaround time (TAT), defined as time from registration of the blood sample in the lab to first result published. Furthermore, we studied, whether TAT is influenced by (1) on- and off-hour-measurements and (2) early versus later patient arrival (cut-off: 270 min after symptom onset). Thirty-eight patients met the eligibility criteria (mean age 77 years, 44 % female). TAT was 34 min (IQR 29-65 min). TATs were similar for on- (n = 14; median 34 min; IQR 30-56 min) and off-hours-TATs (n = 24; median 35 min; IQR 29-75 min) as well as for early (n = 16; median 33 min; IQR 30-40 min) and late patient arrival (n = 22, median 34 min, IQR 28-58 min; all nonsignificant.). Taking into account RivLev in the decision process about the use of intravenous thrombolysis, three patients received intravenous thrombolysis on an individualized basis, none of them with bleeding complications. Emergency measurement of RivLev among patients with acute stroke is available within a median of 34 min and therefore feasible for ED use. Due to the rapid availability, further research to evaluate the role of RivLev in order to guide acute treatment decisions is warranted.

A level‐headed approach to measuring direct oral anticoagulants: A 2‐year retrospective analysis of DOAC levels from a tertiary UK centre

“…Our median TAT for inpatients was 1 hour 32 minutes with no significant difference between levels processed in or out of hours. Although this is slower than other real‐world studies, it is still clinically useful for most emergency and urgent situations. At our institution, urgent requests are flagged to laboratory staff by a combination of location of origin, for example the emergency department, and by telephone.…”

“…The speed with which samples are processed from the point at which they arrive in the laboratory to a result being published is referred to as the turnaround time (TAT) . Few studies have assessed the TAT of DOAC levels but they demonstrate that they can be delivered in a time frame that is clinically relevant . For example, a recent study by Dincq et al achieved median TAT of 61 minutes and 67.6 minutes for apixaban and rivaroxaban respectively.…”

“…34 Few studies have assessed the TAT of DOAC levels but they demonstrate that they can be delivered in a time frame that is clinically relevant. 34,35 For example, a recent study by Dincq et al achieved median TAT of 61 minutes and 67.6 minutes for apixaban and rivaroxaban respectively. In the period immediately preceding the study, the median TAT for DOAC levels was 4 hours 6 minutes.…”

Monitoring DOACs with a Novel Dielectric Microsensor: A Clinical Study

“…A limitation of these tests is the preparation of plasma, which under ideal conditions takes approximately 35 minutes. 30 Moreover, standard coagulation tests have inadequacies when used to monitor DOACs due to significant variability in methodology and reagents used. 1,[31][32][33][34][35][36][37] Therefore, a coagulation test that can be procured and processed at the POC, provides a binary yes or no answer for the presence of DOAC anticoagulant effect, exhibits improved reliability and sensitivity over standard coagulation tests, and is cost effective would be of significant benefit.…”

Reduction of the turn‐around time for the measurement of rivaroxaban and apixaban: Assessment of the performance of a rapid centrifugation method

“…However, details on the preanalytical and analytical processed used to achieve this TAT were not given. 9 The same team has also recently shown that determining rivaroxaban levels within a short TAT allowed thrombolysis for one-third of patients taking rivaroxaban who would otherwise be ineligible for this procedure. 10 Our real-life study confirms the possibility of reducing the TAT around 30 minutes for specific rivaroxaban and apixaban assays.…”