Helin , T A , Virtanen , L , Manninen , M , Leskinen , J , Leppilahti , J , Joutsi-Korhonen , L & Lassila , R 2017 , ' Effects of thromboprophylactic doses of apixaban and rivaroxaban on coagulation and thrombin generation in association with total hip replacement ' , Journal of Thrombosis and Thrombolysis , vol. 43 , no. 4 , pp. 562-569 . https://doi.org/10.1007/s11239-017-1492-2
Title: | Effects of thromboprophylactic doses of apixaban and rivaroxaban on coagulation and thrombin generation in association with total hip replacement |
Author: | Helin, Tuukka A.; Virtanen, Lauri; Manninen, Mikko; Leskinen , Jarkko; Leppilahti, Juhana; Joutsi-Korhonen, Lotta; Lassila, Riitta |
Contributor organization: | Medicum University of Helsinki Department of Diagnostics and Therapeutics Clinicum Department of Clinical Chemistry and Hematology HUSLAB Department of Surgery HUS Comprehensive Cancer Center HUS Musculoskeletal and Plastic Surgery |
Date: | 2017-05 |
Language: | eng |
Number of pages: | 8 |
Belongs to series: | Journal of Thrombosis and Thrombolysis |
ISSN: | 0929-5305 |
DOI: | https://doi.org/10.1007/s11239-017-1492-2 |
URI: | http://hdl.handle.net/10138/236791 |
Abstract: | 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(A (R))) 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 R-2 = 0.44, APTT R-2 = 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. |
Subject: |
Anticoagulants
Apixaban Blood coagulation tests Drug monitoring Rivaroxaban Thrombin generation FACTOR XA INHIBITOR MAJOR ORTHOPEDIC-SURGERY VENOUS THROMBOEMBOLISM ANTICOAGULANTS ASSAYS ARTHROPLASTY INFLAMMATION ENOXAPARIN ROUTINE SYSTEM 3121 General medicine, internal medicine and other clinical medicine |
Peer reviewed: | Yes |
Usage restriction: | openAccess |
Self-archived version: | acceptedVersion |
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