title: Feasibility of rapid measurement of Rivaroxaban plasma levels in patients with acute stroke.
abstract: Plasma levels of Rivaroxaban (RivLev) might be useful to guide therapeutic decisions in patients with acute stroke under Rivaroxaban. A prerequisite for the potential clinical usefulness is their rapid availability in emergency situations. Single-center explorative analysis from the Novel-Oral-Anticoagulants-in-Stroke-Patients-registry (NOACISP, cinicaltrials.gov:NCT02353585). We included consecutive patients with acute ischemic or hemorrhagic stroke under Rivaroxaban (last intake <48 h) in which RivLev determined by an automated anti-factor Xa-based chromogenic assay (Hyphen-Biomed, France) are available. Primary endpoint was the turnaround time (TAT), defined as time from registration of the blood sample in the lab to first result published. Furthermore, we studied, whether TAT is influenced by (1) on- and off-hour-measurements and (2) early versus later patient arrival (cut-off: 270 min after symptom onset). Thirty-eight patients met the eligibility criteria (mean age 77 years, 44 % female). TAT was 34 min (IQR 29-65 min). TATs were similar for on- (n = 14; median 34 min; IQR 30-56 min) and off-hours-TATs (n = 24; median 35 min; IQR 29-75 min) as well as for early (n = 16; median 33 min; IQR 30-40 min) and late patient arrival (n = 22, median 34 min, IQR 28-58 min; all nonsignificant.). Taking into account RivLev in the decision process about the use of intravenous thrombolysis, three patients received intravenous thrombolysis on an individualized basis, none of them with bleeding complications. Emergency measurement of RivLev among patients with acute stroke is available within a median of 34 min and therefore feasible for ED use. Due to the rapid availability, further research to evaluate the role of RivLev in order to guide acute treatment decisions is warranted.
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. david.seiffge@usb.ch.|University of Basel, Basel, Switzerland. david.seiffge@usb.ch.
authors.forename: David J
authors.initials: DJ
authors.lastname: Seiffge
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Christopher
authors.initials: C
authors.lastname: Traenka
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Polymeris
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hert
authors.affiliation: Stroke Center and Neurosurgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Fisch
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Nils
authors.initials: N
authors.lastname: Peters
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: De Marchis
authors.affiliation: Stroke Center and Neurosurgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Guzman
authors.affiliation: Emergency Department, University Hospital Basel, Basel, Switzerland.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nickel
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Lyrer
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
authors.forename: Leo H
authors.initials: LH
authors.lastname: Bonati
authors.affiliation: Diagnostic Hematology, University Hospital Basel, Basel, Switzerland.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsakiris
authors.affiliation: Stroke Center and Neurology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.|Neurorehabilitation Unit, Felix Platter Hospital, University Center for Medicine of Aging, University of Basel, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Engelter
mesh_terms: D000368:Aged; D002863:Chromogenic Compounds / Q000032:analysis; D016903:Drug Monitoring / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D000069552:Rivaroxaban / Q000097:blood*; D020521:Stroke / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D002863:Chromogenic Compounds; D000069552:Rivaroxaban
keywords: Emergency measurement; Plasma levels; Rivaroxaban; Stroke