PMID- 32113855
OWN - NLM
STAT- MEDLINE
DCOM- 20201221
LR  - 20201221
IS  - 2213-3348 (Electronic)
VI  - 8
IP  - 5
DP  - 2020 Sep
TI  - Can an anti-Xa assay for unfractionated heparin be used to assess the presence of 
      rivaroxaban in critical situations?
PG  - 741-747
LID - S2213-333X(20)30068-8 [pii]
LID - 10.1016/j.jvsv.2019.12.079 [doi]
AB  - OBJECTIVE: Although rivaroxaban has recently become widely used for thrombosis 
      treatment, it is difficult for clinicians to make clinical decisions in critical 
      situations, such as emergent surgery or interventions, because a specific anti-Xa 
      assay is not available in many laboratories. This study assessed the 
      relationships between rivaroxaban-specific anti-factor Xa activity (AXA) and 
      unfractionated heparin (UFH)-specific AXA and determined the cutoff level for 
      UFH-specific AXA in critical situations for patients undergoing rivaroxaban 
      therapy. METHODS: Thirty-eight blood samples were collected from patients with 
      cancer-associated thrombosis receiving rivaroxaban therapy. All samples were 
      assessed using both rivaroxaban-specific and UFH-specific anti-Xa assays. Routine 
      coagulation studies, including prothrombin time (PT) and activated partial 
      thromboplastin time, were also conducted on the samples. RESULTS: A positive 
      dose-dependent correlation between rivaroxaban-specific and UFH-specific AXA was 
      evident (R = 0.97; P < .0001). Rivaroxaban-specific AXA was also positively 
      correlated with PT (R = 0.95; P < .0001) but only weakly with activated partial 
      thromboplastin time (R = 0.67; P < .0001). Patients with plasma rivaroxaban 
      concentrations <100 ng/mL were found to have UFH-specific AXA <1.41 IU/mL and 
      PT <17.3 seconds, with sensitivities of 100% and 93.3% and specificities of 87.0% 
      and 95.7%, respectively. CONCLUSIONS: Our study demonstrates that UFH-calibrated 
      AXA correlates strongly with plasma rivaroxaban concentration. This assay appears 
      to be sensitive to the presence of rivaroxaban, which may be advantageous in the 
      setting of assessing drug levels for critical events. These findings suggest that 
      if a rivaroxaban-specific anti-Xa assay is unavailable, the chromogenic anti-Xa 
      assay for UFH may be useful to assess the anticoagulant effects of rivaroxaban.
CI  - Copyright (c) 2020 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Shin, Hyoshim
AU  - Shin H
AD  - Department of Laboratory Medicine, Gyeongsang National University Hospital, 
      Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
FAU - Koh, Eun-Ha
AU  - Koh EH
AD  - Department of Laboratory Medicine, Gyeongsang National University Hospital, 
      Gyeongsang National University College of Medicine, Jinju, Republic of Korea; 
      Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of 
      Korea. Electronic address: ehkohmd@gnu.ac.kr.
FAU - Lee, Gyeong-Won
AU  - Lee GW
AD  - Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of 
      Korea; Department of Internal Medicine, Gyeongsang National University Hospital, 
      Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
FAU - Song, Haa-Na
AU  - Song HN
AD  - Department of Internal Medicine, Gyeongsang National University Hospital, 
      Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
FAU - Kim, Hyun-Young
AU  - Kim HY
AD  - Department of Laboratory Medicine and Genetics, Samsung Medical Center, 
      Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
FAU - Park, Sungwoo
AU  - Park S
AD  - Department of Internal Medicine, Gyeongsang National University Hospital, 
      Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
LA  - eng
PT  - Journal Article
DEP - 20200227
PL  - United States
TA  - J Vasc Surg Venous Lymphat Disord
JT  - Journal of vascular surgery. Venous and lymphatic disorders
JID - 101607771
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*pharmacology
MH  - Blood Coagulation/*drug effects
MH  - *Blood Coagulation Tests
MH  - Clinical Decision-Making
MH  - *Drug Monitoring
MH  - Factor Xa Inhibitors/*blood
MH  - Female
MH  - Heparin/*pharmacology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neoplasms/complications
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Reproducibility of Results
MH  - Rivaroxaban/*blood
MH  - Venous Thromboembolism/blood/diagnosis/*drug therapy/etiology
OTO - NOTNLM
OT  - Anti-Xa assay
OT  - Anticoagulants
OT  - Cancer
OT  - Factor Xa inhibitors
OT  - Rivaroxaban
OT  - Thrombosis
EDAT- 2020/03/03 06:00
MHDA- 2020/12/22 06:00
CRDT- 2020/03/02 06:00
PHST- 2019/09/08 00:00 [received]
PHST- 2019/12/27 00:00 [accepted]
PHST- 2020/03/03 06:00 [pubmed]
PHST- 2020/12/22 06:00 [medline]
PHST- 2020/03/02 06:00 [entrez]
AID - S2213-333X(20)30068-8 [pii]
AID - 10.1016/j.jvsv.2019.12.079 [doi]
PST - ppublish
SO  - J Vasc Surg Venous Lymphat Disord. 2020 Sep;8(5):741-747. doi: 
      10.1016/j.jvsv.2019.12.079. Epub 2020 Feb 27.