Key result
Apixaban 5 mg twice daily was associated with significantly higher mean trough anti-Xa activity compared to rivaroxaban 20 mg once daily (1.79 vs 1.25 IU/mL; P<0.01).
Why the study?
Does apixaban 5 mg twice daily compared to rivaroxaban 20 mg once daily result in different trough anti-Xa activity?
Observational
No
Does apixaban 5 mg twice daily compared to rivaroxaban 20 mg once daily result in different trough anti-Xa activity?
Absolute Event Rate: 1.79% vs 1.25%
p-value: p=< 0.01
There is a good correlation between anti-Xa activity and serum levels for both apixaban and rivaroxaban, with apixaban demonstrating significantly higher trough anti-Xa activity, though the clinical utility of this finding remains to be established.
Trough anti-Xa differences between standard-dose apixaban and rivaroxaban may affect monitoring interpretation; leaves open effects on clinical outcomes.
BACKGROUND: ranging from 0.88 to 0.99. However, there are minimal data in patients receiving apixaban 5 mg twice daily or rivaroxaban 20 mg once daily. OBJECTIVE: To evaluate the anti-Xa activity and serum levels at those doses and compare the trough anti-Xa activity. METHODS: This was a single-center prospective study,approved by the institutional review board. Patients on an inappropriate dose or receiving an interacting drug were excluded. Blood samples were drawn 0.5 to 3 hours before a dose for both agents, 2 to 3 hours after an apixaban dose, and 12 to 16 hours after a rivaroxaban dose. Anti-Xa activity and serum levels were determined, and correlation was done via regression analysis. Trough anti-Xa activity was compared using a t-test. RESULTS: values were 0.79 and 0.87 for apixaban and rivaroxaban, respectively. The mean trough anti-Xa activity was 1.79 ± 0.96 IU/mL for apixaban and 1.25 ± 0.88 IU for rivaroxaban ( P < 0.01). The trough sample was drawn a mean of 1.3 and 1.8 hours prior to the next dose for apixaban and rivaroxaban, respectively ( P < 0.01). CONCLUSIONS: Good correlation was shown between anti-Xa activity and serum levels. The clinical utility of monitoring anti-Xa activity and the significance of the difference in trough anti-Xa activity for these agents remains to be established.
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Bookstaver et al. (2017) conducted an observational in Patients receiving apixaban or rivaroxaban. Apixaban vs. Rivaroxaban 20 mg once daily was evaluated on Trough anti-Xa activity (p=< 0.01). Apixaban 5 mg twice daily was associated with significantly higher mean trough anti-Xa activity compared to rivaroxaban 20 mg once daily (1.79 vs 1.25 IU/mL; P<0.01).
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