Key result
Apixaban and rivaroxaban show comparable thrombin inhibition without rebound hypercoagulability after abrupt discontinuation.
Why the study?
Comparative pharmacokinetics and pharmacodynamics of apixaban and rivaroxaban had not been studied in dogs, and the potential for rebound hypercoagulability after discontinuation was unknown.
Do apixaban and rivaroxaban produce comparable anticoagulant effects and cause rebound hypercoagulability after abrupt discontinuation in healthy dogs?
Do apixaban and rivaroxaban produce comparable anticoagulant effects and cause rebound hypercoagulability after abrupt discontinuation in healthy dogs?
In healthy dogs, apixaban and rivaroxaban provided comparable thrombin inhibition without causing rebound hypercoagulability, suggesting weaning of these drugs in clinical veterinary patients may not be necessary.
BACKGROUND: Comparative pharmacokinetics and pharmacodynamics (PK/PD) of apixaban and rivaroxaban have not been studied in dogs and the propensity of these drugs to cause hypercoagulability after discontinuation is unknown. HYPOTHESIS: Compare the PK/PD of clinical dosing regimens of PO apixaban and rivaroxaban administered repeatedly to healthy dogs and assess the effect of abrupt drug discontinuation on coagulation. ANIMALS: Six University-owned, purpose-bred, middle-aged, mixed-breed dogs (4 male, 2 female). METHODS: Dogs were given apixaban or rivaroxaban PO at 0.5 mg/kg q12h for 7 days with a 14-day washout period between drugs. Plasma drug concentrations were quantitated, and anticoagulant effects were measured using clotting times, calibrated anti-Xa bioactivity assays, and measurements of thrombin generation. The potential for rebound hypercoagulability was assessed by measuring D-dimers, thrombin-antithrombin (TAT) complexes, and antithrombin activity after drug discontinuation. RESULTS: Plasma drug concentrations and anti-Xa bioactivities were closely correlated for both drugs, but drug concentrations varied considerably among dogs, despite consistent dose regimens. Thrombin generation variables were significantly correlated with the anti-Xa bioactivity of both drugs and no significant differences in the effects of apixaban and rivaroxaban on thrombin generation were observed. Drug discontinuation had no effect on D-dimer concentrations. The concentration of TAT complexes decreased after apixaban discontinuation and did not change after rivaroxaban discontinuation. CONCLUSIONS AND CLINICAL IMPORTANCE: Repeated PO administration of apixaban or rivaroxaban to healthy dogs produced comparable anticoagulant effects measured by inhibition of thrombin formation. Rebound hypercoagulability after drug discontinuation was not observed and weaning of these drugs in clinical patients might not be necessary.
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Lynch et al. (2024) studied Healthy dogs (n=6). Apixaban and Rivaroxaban vs. Baseline / Each other (crossover design) was evaluated on Pharmacokinetics (plasma concentrations) and pharmacodynamics (anti-Xa bioactivity, thrombin generation, D-dimers, TAT complexes). Repeated oral administration of apixaban or rivaroxaban in healthy dogs produced comparable inhibition of thrombin formation, without evidence of rebound hypercoagulability after abrupt drug discontinuation.
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