Estimation of Rivaroxaban Plasma Concentrations in the Perioperative Setting in Patients With or Without Heparin Bridging.
BACKGROUND
Estimation of residual rivaroxaban plasma concentrations may be requested before invasive procedures and some patients at high thromboembolic risk will have a bridging therapy with heparins when rivaroxaban is interrupted.


OBJECTIVE
The objective of this study was to assess the performance of the STA-Liquid Anti-Xa assay (STA LAX) and the low and normal procedures of the Biophen Direct Factor Xa Inhibitors (DiXaI) assay, in patients with and without bridging with low-molecular-weight heparins (LMWHs).


METHODS
Seventy-nine blood samples were collected from 77 patients on rivaroxaban at CTROUGHor before an invasive procedure. Rivaroxaban plasma concentrations were estimated using Biophen DiXaI, Biophen DiXaI LOW, and STA LAX and compared to liquid chromatography coupled with mass spectrometry (LC-MS/MS) measurements. Stratifications were performed according to heparin bridging.


RESULTS
The Biophen DiXaI LOW and STA LAX showed better correlation with LC-MS/MS measurements than Biophen DiXaI in patients not bridged with LMWH (R: 0.97, 0.96, and 0.91, respectively). However, the performance of Biophen DiXaI LOW and STA LAX decreased when residual LMWH activity was present (R: 0.18 and 0.19 respectively) demonstrating that these tests are not specific to rivaroxaban.


CONCLUSIONS
In patients not bridged with LMWH, we suggest to use the Biophen DiXaI LOW and STA LAX for the estimation of rivaroxaban concentrations <50 ng/mL. These results should be confirmed on a larger cohort of patients. Patients bridged with LMWH have inaccurate estimates of low levels of rivaroxaban and the 3 assays studied should not be used to estimate if it is safe to perform a procedure.
1 Department of Anesthesiology, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute for LIfe Sciences (NARILIS), Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium.|2 Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium.
Sarah
S
Lessire
2 Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium.
Jonathan
J
Douxfils
2 Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium.
Lionel
L
Pochet
1 Department of Anesthesiology, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute for LIfe Sciences (NARILIS), Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium.
Anne-Sophie
AS
Dincq
3 Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute for LIfe Sciences (NARILIS), Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium.
Anne-Sophie
AS
Larock
1 Department of Anesthesiology, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute for LIfe Sciences (NARILIS), Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium.
Maximilien
M
Gourdin
2 Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute for LIfe Sciences (NARILIS), University of Namur, Namur, Belgium.
Jean-Michel
JM
Dogné
4 Haematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute for LIfe Sciences (NARILIS), Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium.
Bernard
B
Chatelain
4 Haematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute for LIfe Sciences (NARILIS), Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium.
François
F
Mullier
D000328:Adult; D002853:Chromatography, Liquid; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D013058:Mass Spectrometry; D019990:Perioperative Care; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000493:pharmacokinetics; D013923:Thromboembolism / Q000097:blood / Q000517:prevention & control
D006495:Heparin, Low-Molecular-Weight; D000069552:Rivaroxaban
anticoagulants; drug monitoring; heparin; low-molecular-weight; perioperative period; rivaroxaban