PMID- 32433187
OWN - NLM
STAT- MEDLINE
DCOM- 20210818
LR  - 20210818
IS  - 1536-3694 (Electronic)
IS  - 0163-4356 (Linking)
VI  - 42
IP  - 5
DP  - 2020 Oct
TI  - Perils of Antithrombotic Transitions: Effect of Oral Factor Xa Inhibitors on the 
      Heparin Antifactor Xa Assay.
PG  - 737-743
LID - 10.1097/FTD.0000000000000774 [doi]
AB  - BACKGROUND: Oral factor Xa inhibitors (OFXais) may interfere with the heparin 
      antifactor Xa (antiXa) assay. The best method to measure heparin activity during 
      the transition from an OFXai to intravenous (IV) unfractionated heparin (UFH) 
      remains unknown. This study aimed to assess the safety and effectiveness of 
      transitioning from an OFXai to UFH. METHODS: A retrospective analysis was 
      conducted of patients with supratherapeutic antiXa levels on UFH who received 
      either apixaban or rivaroxaban within 72 hours before UFH initiation at NYU 
      Langone Health. The primary objective was to identify the incidence of 
      interference on the heparin antiXa assay due to OFXai exposure in the previous 72 
      hours. The secondary outcomes included the indication for transition to UFH and 
      the rate of thromboembolic and bleeding events. RESULTS: A total of 93 patients 
      with supratherapeutic antiXa activity levels with prior OFXai use were reviewed. 
      Moderate renal impairment, defined as creatinine clearance less than 49 mL/min, 
      was present in 67 (72%) patients. The primary indication for transition from 
      OFXai to UFH was in anticipation for a procedure, and it occurred in 37 (40%) 
      patients. There were 3 major bleeding events and 3 clinically relevant nonmajor 
      bleeding events. No thromboembolic events occurred. CONCLUSIONS: This study 
      assessed the prevalence of supratherapeutic antiXa levels and clinical outcomes 
      during the transition from OFXais to UFH. Health care systems should develop 
      guidelines to assist clinicians in monitoring antiXa activity in patients 
      undergoing a transition from an OFXai to UFH. It is also important to assess the 
      patient's underlying thromboembolic and bleeding risks.
FAU - Ahuja, Tania
AU  - Ahuja T
AD  - Department of Pharmacy, NYU Langone Health, New York, NY.
FAU - Yang, Irene
AU  - Yang I
FAU - Huynh, Quy
AU  - Huynh Q
FAU - Papadopoulos, John
AU  - Papadopoulos J
FAU - Green, David
AU  - Green D
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Ther Drug Monit
JT  - Therapeutic drug monitoring
JID - 7909660
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Pyrazoles)
RN  - 0 (Pyridones)
RN  - 3Z9Y7UWC1J (apixaban)
RN  - 9005-49-6 (Heparin)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
SB  - IM
MH  - Administration, Oral
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/metabolism/therapeutic use
MH  - Blood Coagulation Tests/methods
MH  - Drug Monitoring/methods
MH  - Factor Xa Inhibitors/*metabolism/therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/*metabolism/therapeutic use
MH  - Hemorrhage/drug therapy/metabolism
MH  - Heparin/*metabolism/therapeutic use
MH  - Humans
MH  - Male
MH  - Pyrazoles/metabolism/therapeutic use
MH  - Pyridones/metabolism/therapeutic use
MH  - Retrospective Studies
MH  - Rivaroxaban/metabolism/therapeutic use
MH  - Thromboembolism/drug therapy/metabolism
EDAT- 2020/05/21 06:00
MHDA- 2021/08/19 06:00
CRDT- 2020/05/21 06:00
PHST- 2020/05/21 06:00 [pubmed]
PHST- 2021/08/19 06:00 [medline]
PHST- 2020/05/21 06:00 [entrez]
AID - 00007691-202010000-00014 [pii]
AID - 10.1097/FTD.0000000000000774 [doi]
PST - ppublish
SO  - Ther Drug Monit. 2020 Oct;42(5):737-743. doi: 10.1097/FTD.0000000000000774.