The reversal effect of prothrombin complex concentrate (PCC), activated PCC and recombinant activated factor VII in apixaban‐treated patients in vitro

Figures

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  Figure 1. Reversal of the anticoagulant effect of apixaban by reversal agents shown in a representative thrombogram. A representative thrombogram of a control and an apixaban‐treated patient with and without reversal agents is shown. The reversal agents in a 100% dose are shown: prothrombin complex concentrate (PCC) (40 IU/kg), activated PCC (aPCC) (50 IU/kg) and recombinant factor VIIa (rFVIIa) (90 μg/kg)

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  Figure 2. Difference in thrombin generation parameters after the addition of reversal agents in different doses to samples from apixaban‐treated patients. Values are differences in percent between the baseline value (patient sample without the addition of a reversal agent) and the value obtained after the addition of a reversal agent in three different doses. (A) Lag time in platelet poor plasma (PPP) (minutes). (B) Peak height of thrombin in PPP (nM). (C) Velocity index in PPP (nM/min). (D) Endogenous Thrombin Potential (ETP) in PPP (nM*min). The control level is illustrated by the dotted line and represents the mean difference in percent between the patient baseline value and the mean value of the controls. *P<0.005. PCC, prothrombin complex concentrate; aPCC, activated PCC; rFVIIa, recombinant factor VIIa

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  Figure 3. Differences in clotting time in whole blood (thromboelastometry) after the addition of reversal agents in different doses to samples from apixaban‐treated patients. Values expressed as differences in percent between the baseline value (clotting time in the patient sample without the addition of a reversal agent) and the value obtained after the addition of a reversal agent in three different doses. The control level is illustrated by the dotted line and represents the mean difference in percent between the patient baseline clotting time and the mean clotting time of the controls (706 seconds). *P<0.005. PCC, prothrombin complex concentrate; aPCC, activated prothrombin complex concentrate; rFVIIa, recombinant Factor VIIa

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  Figure 4. Correlation between apixaban concentration and coagulation parameters in apixaban‐ treated patients (n=30). (A) Correlation between the apixaban concentration and the clotting time (CT) in whole blood obtained by thromboelastometry. (ß=0.58, P=0.001). (B) Correlation between the apixaban concentration and the thrombin generation parameter peak height. (ß=−0.58, P=0.001). (C) Correlation between the apixaban concentration and the thrombin generation parameter velocity index. (ß=−0.43, P=0.02) (D) Correlation between the apixaban concentration and the endogenous thrombin potential (ETP). (ß=−0.47, P=0.01)