Laboratory monitoring of rivaroxaban and assessment of its bleeding risk

• Published in: British journal of biomedical science 2016-07, Vol.73 (3), p.134-139
• Main Authors: Zhang, Yuanyuan, Qian, Qingqing, Qian, Guang, Sun, Guangchun
• Format: Article
• Language: English
• Subjects: Adult; Aged; anti-factor Xa chromogenic assay; bleeding risk; Blood Coagulation - drug effects; Conflicts of interest; Factor Xa Inhibitors - therapeutic use; Female; Humans; inhibition of factor Xa activity; Joint replacement surgery; Laboratories; Male; Middle Aged; monitoring; Partial Thromboplastin Time; Patients; Plasma; Prothrombin Time; Rivaroxaban; Rivaroxaban - therapeutic use; Thromboembolism; Thrombosis; Venous Thrombosis - prevention & control; Young Adult
• ISSN: 0967-4845; 2474-0896
• DOI: 10.1080/09674845.2016.1195151

Background: The aims of this study were to investigate the effects of rivaroxaban on routine coagulation assays using our local, widely available, reagents and to study the relationship between sensitive coagulation assays and bleeding risk caused by rivaroxaban. Methods: Prothrombin time (PT), activated partial thromboplastin time (APTT) and anti-factor Xa (FXa) chromogenic assays (Biophen DiXaI) and inhibition of FXa activity were performed in normal pooled plasma (NPP) spiked with rivaroxaban and plasma samples from patients treated with rivaroxaban. Results: In vitro, the linear correlation coefficient of measured concentrations of rivaroxaban, by Biophen DiXaI, and spiked concentrations of rivaroxaban was 0.99. PT and APTT showed good linear correlation with rivaroxaban concentrations, while other assays showed poor correlation. In vivo, PT showed a moderate linear correlation with rivaroxaban concentrations while APTT had a weak correlation with rivaroxaban concentrations. In vitro and in vivo, the rivaroxaban concentrations, measured by Biophen DiXaI, always showed good correlation with the inhibition of FXa activity, and PT values showed moderate correlation with the inhibition of FXa activity. Conclusions: Biophen DiXaI can be considered as a quantitative method to monitor the anticoagulation activity of rivaroxaban, and could be used to evaluate bleeding risk caused by rivaroxaban. The PT reagent (Thrombosis S) could be considered as a rough method to monitor the anticoagulation activity of rivaroxaban and evaluate bleeding risk caused by rivaroxaban.