Using an old test for new tricks: Measuring direct oral anti‐Xa drug levels by conventional heparin‐calibrated anti‐Xa assay

Maier, Cheryl L.; Asbury, William; Duncan, Alexander; Robbins, Adele; Ingle, Ann; Webb, Adam; Stowell, Sean R.; Roback, John D.

doi:10.1002/ajh.25434

Cited by 15 publications

(11 citation statements)

References 6 publications

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“…Similar results were also observed in studies assessing the correlation of anti-Xa measurements with LC-MS/MS in spiked samples ( 27 – 30 ). A high correlation between UFH-calibrated anti-Xa measurements and rivaroxaban-/apixaban-calibrated anti-Xa results was found in a study assessing 241 left-over samples ( 20 ). Besides, van Pelt and colleagues proposed a universal anti-Xa assay reporting the inhibitory effect rather than drug concentrations ( 18 ).…”

Section: Discussionmentioning

confidence: 93%

“…However, these tests are still not widely implemented because it is laborious and expensive to provide three different tests ( 3 ). We and other authors hypothesized that a single heparin-calibrated anti-Xa assay would be sufficient to accurately and efficiently determine rivaroxaban, apixaban, and edoxaban drug levels ( 18 – 20 ). An essential advantage of this method is that heparin-calibrated assays are already available even in smaller laboratories.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of a Single, Heparin-Calibrated Anti-Xa Assay for the Measurement of Rivaroxaban, Apixaban, and Edoxaban Drug Concentrations: A Prospective Cross-Sectional Study

Meihandoest

Studt

Méndez

et al. 2022

Front. Cardiovasc. Med.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Accuracy of a Single, Heparin-Calibrated Anti-Xa Assay for the Measurement of Rivaroxaban, Apixaban, and Edoxaban Drug Concentrations: A Prospective Cross-Sectional Study

Meihandoest

Studt

Méndez

et al. 2022

Front. Cardiovasc. Med.

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“…It does not require equation or conversion factors in contrast to previous studies proposing tools converting "uncalibrated" anti-Xa assay results into DOAC concentrations. [7][8][9][10][11][12] Secondly, we focused on the lower part of the curve to improve precision up to 100 ng/mL, contrary to most studies. [7][8][9][10][11][12] Noteworthy, we observed a clear exponential relationship between LMWH and DOAC anti-Xa activities in this measuring range and evidenced a much better fit than using a linear relationship reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Practical Nomogram Predicting Apixaban or Rivaroxaban Concentrations from Low-Molecular-Weight Heparin Anti-Xa Values: Special Interest in Acute Ischemic Stroke Patients

et al. 2023

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Background and PurposeIn patients with acute ischemic stroke (AIS) using a direct oral factor-Xa anticoagulant (DOAC) during the last 48 hours, a fixed plasma heparin-calibrated anti-Xa activity (0.5 IU/mL) was proposed as a threshold below which patients could be eligible for thrombolysis and/or thrombectomy. Besides, specific DOAC-calibrated anti-Xa thresholds up to 50 ng/mL have been proposed. However, specific DOAC assays are not widely available contrarily to low-molecularweight heparin (LMWH) anti-Xa activity. We developed and validated a nomogram for predicting apixaban and rivaroxaban concentrations based on LMWH anti-Xa assay. Methods Our prospective study included apixaban (n=325) and rivaroxaban (n=276) patients. On the same sample, we systematically measured specific DOAC concentration and LMWH anti-Xa activity, using STA®-Liquid-Anti-Xa (Stago) and specific DOAC-or LMWH-calibrators, respectively. The nomogram was built using quantifiable values for both assays on the derivation cohorts with a log-linear regression model. Model performances including sensitivity, specificity, and true positive rate for different thresholds were checked on the validation cohorts. ResultsThe models built from the derivation cohorts predicted that values <30 ng/mL and <50 ng/ mL DOAC thresholds corresponded to LMWH-anti-Xa values <0.10 IU/mL and <0.64 IU/mL for apixaban; <0.10 IU/mL and <0.71 IU/mL for rivaroxaban. The model accurately predicted apixaban/ rivaroxaban concentrations in the validation cohort. Conclusions This easy-to-use nomogram, developed with our reagent, allowed accurately predicting DOAC concentrations based on LMWH-anti-Xa results in emergency situations such as AIS when drug-specific assessments are not rapidly available. Using DOAC <50 ng/mL equivalent threshold, instead of the fixed LMWH <0.5 IU/mL one, would allow proposing thrombolysis to more patients.

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“…5 The correlation between heparin-calibrated Anti-Xa activity and apixaban-or rivaroxaban-calibrated anti-Xa assays lies above 96%. 6 Given its accuracy and broader availability across Europe, we chose a cut-off based on the heparin-calibrated Anti-Xa activity. The cut-off of <0.5 U/ml corresponds to low Xa inhibiting NOACs concentrations (<50-100 ng/ml).…”

Section: Dear Editorsmentioning

confidence: 99%

Author Reply to “Intravenous thrombolysis in patients taking direct oral anticoagulants (European stroke organisation intravenous thrombolysis guidelines comment)

Marchis

Turc

Whiteley

et al. 2021

European Stroke Journal

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Using an old test for new tricks: Measuring direct oral anti‐Xa drug levels by conventional heparin‐calibrated anti‐Xa assay

Cited by 15 publications

References 6 publications

Accuracy of a Single, Heparin-Calibrated Anti-Xa Assay for the Measurement of Rivaroxaban, Apixaban, and Edoxaban Drug Concentrations: A Prospective Cross-Sectional Study

Accuracy of a Single, Heparin-Calibrated Anti-Xa Assay for the Measurement of Rivaroxaban, Apixaban, and Edoxaban Drug Concentrations: A Prospective Cross-Sectional Study

Practical Nomogram Predicting Apixaban or Rivaroxaban Concentrations from Low-Molecular-Weight Heparin Anti-Xa Values: Special Interest in Acute Ischemic Stroke Patients

Author Reply to “Intravenous thrombolysis in patients taking direct oral anticoagulants (European stroke organisation intravenous thrombolysis guidelines comment)

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