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Preliminary report: Measurement of apixaban and rivaroxaban in plasma from bleeding patients

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OBJECTIVES: The direct oral anticoagulants (DOACs), apixaban and rivaroxaban, are used for anticoagulation treatment. Although biochemical monitoring is not required, severe bleedings caused by DOAC have been reported. We therefore evaluated the chromogenic assay Biophen DiXaI(®) (Biophen) using plasma from non-bleeding patients in treatment with DOAC and on spiked plasma from patients with ongoing bleeding.

METHODS: The Biophen method was compared with an in-house reference method; liquid chromatography-tandem mass spectrometry (LC-MS/MS) using plasma spiked with the compounds ranging from 20 to 1500 μg/L. Furthermore, the methods were compared using plasma from non-bleeding patients in treatment with DOAC (n = 106). In addition, plasma was collected from patients not treated with DOAC, but with ongoing bleeding and tested in spiking experiments (n = 14).

RESULTS: Analysis of plasma from 106 patients receiving rivaroxaban (n = 91) or apixaban (n = 15) showed agreement and correlation between the methods. Measurement in spiked plasma from patients with active bleeding, however, revealed a 26% overestimation by the assay.

CONCLUSIONS: Our findings show that Biophen is suitable for measuring apixaban and rivaroxaban concentrations in plasma. However, our results in patients with active bleeding show an overestimation of 26%. This should be taken into account when assessing possible intoxication with apixaban and rivaroxaban in patients presenting with bleeding.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Haematology
Vol/bind99
Udgave nummer5
Sider (fra-til)431-436
Antal sider6
ISSN0902-4441
DOI
StatusUdgivet - 2017

ID: 51804569