Simple and rapid assay for effect of the new oral anticoagulant (NOAC) rivaroxaban: preliminary results support further tests with all NOACs

Thrombosis Journal

Claudio Daniel Gonzalez²  Raul Altman¹ 

[1] Centro de Trombosis de Buenos Aires, Viamonte 2008, Buenos Aires 1056, Argentina;Catedra de Farmacologia, Facultad de Medicina, Universidad Nacional de Buenos Aires, Viamonte 2008, Buenos Aires 1056, Argentina

关键词: Atrial fibrillation;    DVT;    Anti-factor X activity;    Rivaroxaban;    Oral anticoagulant;    NOACs;   

Others  :  834710
DOI  :  10.1186/1477-9560-12-7

 received in 2013-12-16, accepted in 2014-02-27,  发布年份 2014

【 摘 要 】

Background

New oral anticoagulant (NOAC) drugs are known to influence the results of some routine hemostasis tests. Further data are needed to enable routine assessment of the effects of NOAC on clotting parameters in some special circumstances.

Methods

Following administration of rivaroxaban to patients, at the likely peak and trough activity times, we assessed the effects on prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and clotting time using Russell’s viper venom, and in the presence of phospholipids and calcium reagent available as DVVreagent® and DVVconfirm®. The data were used to determine an adequate NOAC plasma level based on anticoagulant activities expressed as a ratio (patients/normal, R-C).

Results

DVVconfirm as R-C could be rapidly performed, and the results were reasonably sensitive for rivaroxaban and probably for other FX inhibitors. This assay is not influenced by lupus anticoagulant and heparin, does not require purified NOAC as control, and will measure whole-plasma clotting activity.

Conclusions

We propose a cut-off R-C value of 4.52 ± 0.33 for safety, but clinical studies are needed to establish whether this cut-off is useful for identifying patients at increased risk of hemorrhage or exhibiting low anticoagulation effect. It also seems possible that normal R-C could indicate an absence of anticoagulant activity when rivaroxaban is discontinued due to episodes of uncontrolled bleeding during anticoagulation or for emergency surgery.

【 授权许可】

   
2014 Altman and Gonzalez; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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