What question did this study set out to answer?

To evaluate the clinical utility of anti-factor Xa activity, prothrombin time, and activated partial thromboplastin time for monitoring rivaroxaban and apixaban pharmacodynamics in patients with non-valvular atrial fibrillation.

September 15, 2015Journal of ArrhythmiaOpen Access

Clinical implication of monitoring rivaroxaban and apixaban by using anti‐factor Xa assay in patients with non‐valvular atrial fibrillation

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Why the study?

Does the pharmacodynamic profile measured by anti-factor Xa assay differ between rivaroxaban and apixaban in patients with non-valvular atrial fibrillation?

Population

70 patients with non-valvular atrial fibrillation (188 blood samples)

Comparison

Rivaroxaban once daily (n=36) vs Apixaban twice daily (n=34)

Design

Cohort

Authors

KIKozue IkedaShioda General Hospital HTHideaki TachibanaShowa University

Discussion

Member takes

Implication

AXA monitoring may detect elevated trough levels in some apixaban patients; leaves open whether it improves safety or dosing decisions.

Key Points

To evaluate the clinical utility of anti-factor Xa activity, prothrombin time, and activated partial thromboplastin time for monitoring rivaroxaban and apixaban pharmacodynamics in patients with non-valvular atrial fibrillation.
Analyzed 188 blood samples from 70 patients with non-valvular atrial fibrillation, including 36 patients treated with once-daily rivaroxaban and 34 treated with twice-daily apixaban.
Measured anti-factor Xa activity using a chromogenic assay with the HemosIL Liquid Heparin kit alongside prothrombin time and activated partial thromboplastin time.
At peak concentration, anti-factor Xa activity was 2.08±0.91 IU/mL for rivaroxaban versus 1.71±0.57 IU/mL for apixaban, with rivaroxaban showing significantly longer prothrombin time (18.1±5.6 s vs. 13.8±0.9 s, p<0.001) and activated partial thromboplastin time (40.9±7.3 s vs. 35.5±7.5 s, p<0.01).
At trough concentration, rivaroxaban exhibited significantly lower anti-factor Xa activity (0.28±0.31 IU/mL vs. 1.04±0.72 IU/mL, p<0.001) and shorter prothrombin time (11.9±2.0 s vs. 13.7±2.4 s, p<0.01) than apixaban, whereas activated partial thromboplastin time did not differ significantly (32.3±4.3 s vs. 34.3±3.8 s).

Structured PICO

Does the pharmacodynamic profile measured by anti-factor Xa assay differ between rivaroxaban and apixaban in patients with non-valvular atrial fibrillation?

Population

70 patients with non-valvular atrial fibrillation (188 blood samples)

Intervention

Rivaroxaban once daily (n=36)

Comparator

Apixaban twice daily (n=34)

Outcome

Anti-factor Xa activity (AXA), prothrombin time (PT), and activated partial thromboplastin time (aPTT) at peak and trough timessurrogate

Anti-factor Xa assay demonstrates distinct peak and trough pharmacodynamic profiles for rivaroxaban and apixaban, suggesting potential utility for monitoring high-risk patients.

Cite This Study

Ikeda et al. (2015) studied this question.

synapsesocial.com/papers/6a70eccd31a3df8243292bd5 https://doi.org/10.1016/j.joa.2015.08.001

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Clinical implication of monitoring rivaroxaban and apixaban by using anti‐factor Xa assay in patients with non‐valvular atrial fibrillation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Clinical implication of monitoring rivaroxaban and apixaban by using anti‐factor Xa assay in patients with non‐valvular atrial fibrillation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

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