Comparison of the effect of the anti-Xa direct oral anticoagulants apixaban, edoxaban, and rivaroxaban on coagulation assays

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality and is associated with high recurrence rates. The introduction of direct oral anticoagulants (DOACs) in the 2010s has changed the landscape of VTE management. DOACs have become the preferred anticoagulant therapy for their ease of use, predictable pharmacokinetics, and improved safety profile. Increasingly, guidelines have recommended long term anticoagulation for some indications such as following first unprovoked major VTE, although an objective individualised risk assessment for VTE recurrence remains elusive. The balance of preventing VTE recurrence needs to be weighed against the not insignificant bleeding risk, which is cumulative with prolonged use. Hence, there is a need for an individualised, targeted approach for assessing the risk of VTE recurrence, especially in those patients in whom the balance between benefit and risk of long-term anticoagulation is not clear. Clinical factors alone do not provide the level of discrimination required on an individual level. Laboratory data from global coagulation assays and biomarkers may provide enhanced risk assessment ability and are an active area of research. A review of the prediction models and biomarkers for assessing VTE recurrence risk is provided, with an emphasis on contemporary developments in the era of DOACs and global coagulation assays.

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Accidental apixaban intoxication in a 23-month-old child: a case report

BMC Pediatrics ◽

10.1186/s12887-020-02448-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Manon Launay ◽

Yara Nasser ◽

Isabelle Maubert ◽

Anne-Cécile Chaux ◽

Xavier Delavenne

Keyword(s):

Emergency Department ◽

Trough Level ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Case Presentation ◽

Coagulation Assays ◽

Rapid Elimination ◽

Terminal Half Life ◽

High Concentrations ◽

Routine Coagulation

Abstract Background Direct oral anticoagulants, such as apixaban, are increasingly used in everyday practice in order to treat or prevent thromboembolic diseases. To date, there is no available data about apixaban pharmacokinetics in children, and no intoxication has previously been described. Case presentation A 23-month-old boy, with no medical history, was admitted to the emergency department 2 h after accidentally ingesting 40 mg apixaban and 0.75 mg digoxin. No adverse event was observed. Digoxin trough level was within therapeutic values. Apixaban blood concentration increased up to 1712 μg/L at H + 6 (1000–2750 μg/L using 2–5 mg/kg of apixaban in adults). The terminal half-life was 8.2 h (6–15 h in adults). The rapid elimination may explain the absence of bleeding despite high concentrations. Conclusions Despite an important intake of apixaban and a real disturbance in routine coagulation assays, no clinical sign of bleeding was observed, perhaps due to wide therapeutic range of apixaban. It may also be explained by its rapid elimination. Considering the high Cmax and a possible enteroenteric recycling, the use of activated charcoal should be considered in such situations in order to prevent eventual bleeding.

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Evaluation of a rapid centrifugation step (4500 g for 2 min) in coagulation assays to monitor direct oral anticoagulants

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-0410 ◽

2018 ◽

Vol 57 (2) ◽

pp. e37-e40

Author(s):

Justine Brulé ◽

Solène Revy ◽

Charlotte Faure ◽

Romain Eschalier ◽

Grégoire Massoullié ◽

...

Keyword(s):

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Coagulation Assays ◽

Centrifugation Step

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Influence of DOACs and DOAC Remove® on coagulation assays during thrombophilia testing in DOAC treated patients

Vojnosanitetski pregled ◽

10.2298/vsp210217101k ◽

2021 ◽

pp. 101-101

Author(s):

Mirjana Kovac ◽

Dusica Basaric ◽

Branko Tomic ◽

Maja Gvozdenov ◽

Dragana Backovic ◽

...

Keyword(s):

Treated Patient ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Testing Methods ◽

Coagulation Assays ◽

Apc Resistance ◽

R Ratio ◽

Before And After ◽

Thrombophilia Testing ◽

Significant Interference

Background/Aim. Direct oral anticoagulants (DOACs) administration has a significant interference on coagulation assays. Our study was conducted in order to evaluate the effect of DOACs and DOAC Remove? on coagulation assays during thrombophilia testing. Methods. In the period of January 2019 to the end of June 2020 30 DOAC treated patients tested for thrombophilia, due to venous thromboembolism (VTE), 14 females and 16 males aged 23 to 63 years (median age 47.6 years), were included in the study. Thrombophilia testing was performed using DOAC Remove? tablets (activated charcoal). The results before and after DOAC Remove? were compared. Results. Positive LA results were observed in 20% apixaban, 100% dabigatran, and 70% rivaroxaban treated patient, while in samples after DOAC Remove? the LA positivity was observed only in one from the apixaban group. Before DOAC Remove?, the APC-R ratio was measurable in 40% dabigatran, and 80% rivaroxaban treated patients, while, after using DOAC Remove? the APC-R was measurable in all cases. Comparing the results obtained from the samples before and after DOAC Remove?, a difference was noted in relation to all dRVVT tests, except for the dRVVT ratio in the apixaban group. Clot-based methods for detection of the APC resistance are significantly affected by dabigatran, and less by rivaroxaban. Conclusion. DOAC was practically inactivated after the addition of the DOAC Remove?, which made it possible to perform analyses for the LA and APC-R testing freely and obtain relevant results.

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