Impact of apixaban on routine and specific coagulation assays: a practical laboratory guide

Jonathan Douxfils; Christian Chatelain; Bernard Chatelain; Jean-Michel Dogné; François Mullier

doi:10.1160/TH12-12-0898

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2013; 110(02): 283-294
DOI: 10.1160/TH12-12-0898

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Impact of apixaban on routine and specific coagulation assays: a practical laboratory guide

Jonathan Douxfils

¹Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Belgium

,

Christian Chatelain

³Hematology Department, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), CHU UCL Mont-Godinne-Dinant, Belgium

,

Bernard Chatelain

²Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), CHU UCL Mont-Godinne-Dinant, Yvoir, Belgium

,

Jean-Michel Dogné^*

¹Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Belgium

,

François Mullier^*

¹Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for LIfe Sciences (NARILIS), University of Namur, Belgium

²Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), CHU UCL Mont-Godinne-Dinant, Yvoir, Belgium

› Author Affiliations

Abstract

Summary

Apixaban does not require monitoring nor frequent dose adjustment. However, searching for the optimal dose for the individual patient may be useful in some situations. Moreover, there is a need for clinicians to know whether coagulation assays are influenced by apixaban use. The aim of this study was to determine which coagulation assay could be used to assess the impact of apixaban on haemostasis and provide good laboratory recommendations for the accurate interpretation of haemostasis assays. Apixaban is spiked at concentrations ranging from 5 to 500 ng/ml in platelet-poor plasma. Routinely used or more specific coagulation assays are tested. Results show a concentration dependent prolongation of aPTT, PT and dilute PT. The sensitivity mainly depends on the reagent, but none of these tests is sensitive enough to ensure an accurate estimation of the pharmacodynamic effect of apixaban. FXa chromogenic assays show high sensitivity and a linear correlation depending on the reagent and/or the methodology. Immunological assays and assays acting below the FXa are not influenced by apixaban. In conclusion, PT and/or dilute PT cannot be used to assess apixaban pharmacodynamic properties. More specific and sensitive assays such as chromogenic FXa assays using specific calibrators are required. In case of thrombophilia or in the exploration of a haemorrhagic event, immunological assays should be recommended, when applicable. Standardisation of the time between the last intake of apixaban and the sampling is mandatory.

Keywords

Apixaban - monitoring - coagulation assays - assessment - laboratory recommendations

Full Text

References

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