Effects of thromboprophylactic doses of apixaban and rivaroxaban on coagulation and thrombin generation in association with total hip replacement

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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: University of Helsinki, Medicum
University of Helsinki, HUSLAB
University of Helsinki, Clinicum
University of Helsinki, HUSLAB
University of Helsinki, Clinicum
Date: 2017-05
Language: eng
Number of pages: 8
Belongs to series: Journal of Thrombosis and Thrombolysis
ISSN: 0929-5305
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
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