Key result
UPLC-MRM mass spectrometry reliably quantifies routine rivaroxaban plasma levels, revealing wide patient variability.
Why the study?
Laboratory monitoring of rivaroxaban plasma levels is important in some clinical conditions, but suitable routine laboratory methods need to be established.
Observational (n=36)
UPLC-MRM mass spectrometry is a viable method for routine laboratory monitoring of rivaroxaban, highlighting significant inter-patient variability in plasma levels.
May support routine rivaroxaban level monitoring in labs; leaves open whether variability affects outcomes or requires personalized dosing.
BACKGROUND: Direct oral anticoagulants (DOAC’s) are frequently used for different indications. Within the group of DOAC’s one representative is the factor Xa inhibitor rivaroxaban. In general, there are some clinical conditions where laboratory monitoring of DOAC’s can be important. OBJECTIVE: The aim of this study is to establish a mass spectrometric method for the determination of rivaroxaban plasma levels from citrate plasma samples and to make some considerations about the clinical interpretation of the results. METHODS: To determine the rivaroxaban plasma levels a triple quadrupole mass spectrometer equipped with an electrospray ionization ion source was used in combination with an ultra-performance-liquid-chromatography (UPLC) system. RESULTS: The results revealed that the mass spectrometric method is well suitable for the determination of rivaroxaban plasma levels in a routine laboratory. Last but not least the results from 36 patient samples showed that there is a wide variability within the peak and trough levels. The majority of patients showed trough levels above the safety threshold for surgical treatment in an emergency. CONCLUSION: For routine laboratories which already have a mass spectrometer it is a good option to apply this technique for the determination of rivaroxaban plasma levels.
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Schmidt et al. (2019) conducted an observational in Patients taking rivaroxaban (n=36). UPLC-MRM mass spectrometry was evaluated on Rivaroxaban plasma levels. UPLC-MRM mass spectrometry is suitable for determining rivaroxaban plasma levels in a routine laboratory, with 36 patient samples showing wide variability in peak and trough levels.
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