Simple and rapid assay for effect of the new oral anticoagulant NOAC rivaroxaban: preliminary results support further tests with all NOACsReport as inadecuate




Simple and rapid assay for effect of the new oral anticoagulant NOAC rivaroxaban: preliminary results support further tests with all NOACs - Download this document for free, or read online. Document in PDF available to download.

Thrombosis Journal

, 12:7

First Online: 21 March 2014Received: 16 December 2013Accepted: 27 February 2014

Abstract

BackgroundNew 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.

MethodsFollowing 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.

ResultsDVVconfirm 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.

ConclusionsWe 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.

KeywordsNOACs Oral anticoagulant Rivaroxaban Anti-factor X activity DVT Atrial fibrillation Electronic supplementary materialThe online version of this article doi:10.1186-1477-9560-12-7 contains supplementary material, which is available to authorized users.

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Author: Raul Altman - Claudio Daniel Gonzalez

Source: https://link.springer.com/article/10.1186/1477-9560-12-7



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