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Original scientific paper

https://doi.org/10.11613/BM.2020.010702

Chromogenic anti-FXa assay calibrated with low molecular weight heparin in patients treated with rivaroxaban and apixaban: possibilities and limitations

Sandra Margetić ; Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ivana Ćelap ; Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Diana Delić Brkljačić ; Department of Cardiovascular Diseases, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Nikola Pavlović ; Department of Cardiovascular Diseases, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Sandra Šupraha Goreta ; Department of Biochemistry and Molecular Biology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia
Ivana Kobasić ; Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Arijana Lovrenčić-Huzjan ; Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Vanja Bašić Kes ; Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia


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Abstract

Introduction: Clinical application of rivaroxaban and apixaban does not require therapeutic monitoring. Commercial anti-activated factor X (anti-FXa) inhibition methods for all anti-FXa drugs are based on the same principle, so there are attempts to evaluate potential clinical application of heparin-calibrated anti-FXa assay as an alternative method for direct FXa inhibitors. We aimed to evaluate relationship between anti-FXa methods calibrated with low molecular weight heparin (LMWH) and with drug specific calibrators, and to determine whether commercial LMWH anti-FXa assay can be used to exclude the presence of clinically relevant concentrations of rivaroxaban and apixaban.
Materials and methods: Low molecular weight heparin calibrated reagent (Siemens Healthineers, Marburg, Germany) was used for anti-FXa activity measurement. Innovance heparin (Siemens Healthineers, Marburg, Germany) calibrated with rivaroxaban and apixaban calibrators (Hyphen BioMed, Neuville-sur-Oise, France) was used for quantitative determination of FXa inhibitors.
Results: Analysis showed good agreement between LMWH calibrated and rivaroxaban calibrated activity (κ = 0.76) and very good agreement with apixaban calibrated anti-Xa activity (κ = 0.82), respectively. Low molecular weight heparin anti-FXa activity cut-off values of 0.05 IU/mL and 0.1 IU/mL are suitable for excluding the presence of clinically relevant concentrations (< 30 ng/mL) of rivaroxaban and apixaban, respectively. Concentrations above 300 ng/mL exceeded upper measurement range for LMWH anti-FXa assay and cannot be determined by this method.
Conclusion: Low molecular weight heparin anti-FXa assay can be used in emergency clinical conditions for ruling out the presence of clinically relevant concentrations of rivaroxaban and apixaban. However, use of LMWH anti-FXa assay is not appropriate for their quantitative determination as an interchangeable method.

Keywords

apixaban; DOAC; factor Xa inhibitors; LMWH; rivaroxaban

Hrčak ID:

234052

URI

https://hrcak.srce.hr/234052

Publication date:

15.2.2020.

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