All PT and APTT reagents demonstrated higher sensitivity for edoxaban and rivaroxaban than apixaban, while dilute viper venom methods were exquisitely sensitive to all anti-Xa DOACs.
Do apixaban, edoxaban, and rivaroxaban differentially affect routine and special coagulation assays in pooled normal plasma?
Routine PT and APTT assays are inadequate for detecting apixaban, highlighting the need for anti-Xa methods or dilute viper venom tests to screen or measure anti-Xa DOACs.
INTRODUCTION: The purpose of this study is to compare the effect of increasing concentrations of direct anti-Xa oral anticoagulants (DOAC) apixaban-, edoxaban-, and rivaroxaban-enriched plasma samples on various prothrombin time (PT), activated partial thromboplastin time (APTT), heparin calibrated anti-Xa methods, and other coagulation assays. METHODS: Apixaban, edoxaban, or rivaroxaban was dissolved in dimethylsulfoxide and added to pooled normal plasma to obtain concentrations ranging from 0 ng/mL to approximately 600 ng/mL. The samples were tested using Innovin(®) , Neoplastine(®) CI Plus, Recombiplastin 2G, and Thromborel(®) S for PT testing and Actin, Actin(®) FS, Actin(®) FSL, APTT-Automate, and SynthaSIL for APTT. Samples were also tested using four different anti-Xa methods calibrated for unfractionated heparin or low molecular weight heparin. Special coagulation assays included antithrombin activity, lupus anticoagulant assays, and others. For special coagulation assays, the concentration of DOAC that resulted in a >15% change from baseline value was determined. DOAC quantification was performed using liquid chromatography-tandem mass spectrometry. RESULTS: All PT and APTT reagents demonstrated a higher sensitivity for edoxaban and rivaroxaban than for apixaban. Anti-Xa methods were able to detect low concentrations of DOAC. DOACs effected special coagulation assays to differing degrees, with lupus anticoagulant testing using dilute viper venom, the most sensitive test to the presence of anti-Xa DOAC. CONCLUSION: No PT or APTT reagent system effectively detected apixaban. All anti-Xa methods demonstrated sensitivity to low concentrations of DOAC. Dilute viper venom methods are exquisitely sensitive to anti-Xa DOAC, suggesting potential use of this assay for screening or measuring these drugs.
Gosselin et al. (Mon,) reported a other. Direct anti-Xa oral anticoagulants (apixaban, edoxaban, rivaroxaban) vs. Baseline (0 ng/mL) was evaluated on Effect on PT, APTT, anti-Xa, and special coagulation assays. All PT and APTT reagents demonstrated higher sensitivity for edoxaban and rivaroxaban than apixaban, while dilute viper venom methods were exquisitely sensitive to all anti-Xa DOACs.