Effects of thromboprophylactic doses of apixaban and rivaroxaban on coagulation and thrombin generation in association with total hip replacement.
Factor Xa inhibitors (FXaI) apixaban and rivaroxaban are used for thromboprophylaxis after major elective orthopaedic surgery. Because few patient sample studies exist, we postoperatively assessed patients undergoing unilateral total hip arthroplasty, including 22 treated with apixaban (2.5 mg BID) and 20 treated with rivaroxaban (10 mg OD). We collected blood samples before and 3 h after drug intake at 4 time points, preoperatively, as well as on day 1, week 1 (day 2-8) and day 28 post-operation. APTT and PT were immediately analysed. Calibrated anti-FXa activity, Russel's Viper Venom Time (RVVT) and thrombin generation (TG; Calibrated Automated Thrombogram®) captured the effects of FXaI on coagulation and TG. APTT and PT remained within the reference interval throughout, and did not correlate with FXaI levels (PT R2= 0.44, APTT R2= 0.07). Mean apixaban concentration at the peak varied by eightfold (19-153 ng/mL), but rivaroxaban only by 1.5-fold (111-183 ng/mL). Rivaroxaban, but not apixaban prolonged RVVT at peak levels. Both FXaIs had a prolonged lag time of TG (p < 0.001). Rivaroxaban decreased ETP peak at all time points and reached a minimum at day 28 (540 nM/min at rivaroxaban 184 ng/mL, p < 0.001), while rivaroxaban trough levels were low and ETP values normal. However, with apixaban, after an initial decrease, ETP did not differ between peak and trough levels until decreasing on day 28 at peak (990 nM/min at apixaban 112 ng/mL, p = 0.005). In conclusion, due to different dosing and pharmacology rivaroxaban and apixaban distinctly inhibited TG under postoperative conditions.
Coagulation Disorders Unit, Clinical Chemistry, HUSLAB Laboratory Services, Helsinki University Hospital, Helsinki, Finland.
Tuukka A
TA
Helin
Coagulation Disorders Unit, Hematology and Clinical Chemistry (HUSLAB Laboratory Services), Helsinki University Hospital, and University of Helsinki, POB 340, 00029, Helsinki, Finland.
Lauri
L
Virtanen
Orton Orthopaedic Hospital, Helsinki, Finland.
Mikko
M
Manninen
Peijas Hospital, Helsinki University Hospital, Vantaa, Finland.
Jarkko
J
Leskinen
Oulu University Hospital, Oulu, Finland.
Juhana
J
Leppilahti
Coagulation Disorders Unit, Clinical Chemistry, HUSLAB Laboratory Services, Helsinki University Hospital, Helsinki, Finland.
Lotta
L
Joutsi-Korhonen
Coagulation Disorders Unit, Hematology and Clinical Chemistry (HUSLAB Laboratory Services), Helsinki University Hospital, and University of Helsinki, POB 340, 00029, Helsinki, Finland. riitta.lassila@hus.fi.|CSO of Aplagon Ltd, Helsinki, Finland. riitta.lassila@hus.fi.
Riitta
R
Lassila
D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests / Q000295:instrumentation / Q000379:methods; D004338:Drug Combinations; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D011292:Premedication / Q000379:methods*; D011720:Pyrazoles / Q000008:administration & dosage*; D011728:Pyridones / Q000008:administration & dosage*; D000069552:Rivaroxaban / Q000008:administration & dosage*; D013917:Thrombin / Q000096:biosynthesis* / Q000187:drug effects; D013997:Time Factors
D004338:Drug Combinations; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban; D013917:Thrombin
Anticoagulants; Apixaban; Blood coagulation tests; Drug monitoring; Rivaroxaban; Thrombin generation