PMID- 38314168
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240206
IS  - 2475-0379 (Electronic)
IS  - 2475-0379 (Linking)
VI  - 8
IP  - 1
DP  - 2024 Jan
TI  - Acute ischemic stroke and measurement of apixaban and rivaroxaban: an 
      observational cohort implementation study.
PG  - 102307
LID - 10.1016/j.rpth.2023.102307 [doi]
LID - 102307
AB  - BACKGROUND: Treatment with intravenous thrombolysis for acute ischemic stroke is 
      contraindicated with intake of apixaban/rivaroxaban in the last 48 hours. Recent 
      European Stroke Organization guidelines suggest that thrombolysis can be 
      considered if anti-factor Xa activity (AFXa) is <0.5 x 10(3) IU/L with 
      low-molecular-weight (LMWH) or unfractionated heparin (UFH) calibrated assays. 
      Some centers also use apixaban/rivaroxaban-calibrated AFXa assays to identify 
      patients with low drug concentrations. OBJECTIVES: To prospectively evaluate the 
      first year of implementation of drug-calibrated AFXa assays at our center with 
      2500 yearly admittances with suspected stroke. METHODS: Samples were analyzed on 
      Sysmex CS-5100 instruments with Innovance anti-Xa reagents. Thrombolysis could be 
      considered with drug concentrations <25 mug/L. Patients were registered in an 
      institutionally approved quality register. Outcomes included (1) the number of 
      patients receiving thrombolysis after drug measurement, (2) turn-around time for 
      drug concentration measurements, and (3) sensitivity of LMWH/UFH AFXa to apixaban 
      and rivaroxaban. RESULTS: Apixaban or rivaroxaban was measured in 148 samples, 
      and 4 patients who previously would have been ineligible for thrombolysis were 
      treated with thrombolysis. In total, thrombolysis was administered in 123 patient 
      episodes in the study period. The median turn-around time for the drug 
      measurements was 38 minutes. Apixaban concentrations of 25 mug/L and 50 mug/L 
      corresponded to LMWH/UFH AFXa of 0.13 and 0.27 x 10(3) IU/L, respectively. There 
      were too few rivaroxaban results for regression analysis. CONCLUSION: 
      Implementation of apixaban and rivaroxaban measurements led to a small increase 
      in the number of patients receiving thrombolysis. Excluding significant 
      concentrations of apixaban or rivaroxaban using LMWH/UFH AFXa may be feasible.
CI  - (c) 2024 The Authors.
FAU - Amundsen, Erik Koldberg
AU  - Amundsen EK
AD  - Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
FAU - Ihle-Hansen, Hege
AU  - Ihle-Hansen H
AD  - Oslo Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, 
      Norway.
FAU - Kraglund, Kristian Lundsgaard
AU  - Kraglund KL
AD  - Oslo Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, 
      Norway.
FAU - Hagberg, Guri
AU  - Hagberg G
AD  - Oslo Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, 
      Norway.
LA  - eng
PT  - Journal Article
DEP - 20240102
PL  - United States
TA  - Res Pract Thromb Haemost
JT  - Research and practice in thrombosis and haemostasis
JID - 101703775
PMC - PMC10837088
OTO - NOTNLM
OT  - apixaban
OT  - factor Xa inhibitors
OT  - rivaroxaban
OT  - stroke
OT  - thrombolytic therapy
EDAT- 2024/02/05 06:43
MHDA- 2024/02/05 06:44
PMCR- 2024/01/02
CRDT- 2024/02/05 05:00
PHST- 2023/07/28 00:00 [received]
PHST- 2023/12/04 00:00 [revised]
PHST- 2023/12/06 00:00 [accepted]
PHST- 2024/02/05 06:44 [medline]
PHST- 2024/02/05 06:43 [pubmed]
PHST- 2024/02/05 05:00 [entrez]
PHST- 2024/01/02 00:00 [pmc-release]
AID - S2475-0379(23)05735-7 [pii]
AID - 102307 [pii]
AID - 10.1016/j.rpth.2023.102307 [doi]
PST - epublish
SO  - Res Pract Thromb Haemost. 2024 Jan 2;8(1):102307. doi: 
      10.1016/j.rpth.2023.102307. eCollection 2024 Jan.