Edoxaban: Impact on routine and specific coagulation assays A practical laboratory guide

被引:54
作者
Douxfils, Jonathan
Chatelain, Bernard [1 ]
Chatelain, Christian [2 ]
Dogne, Jean-Michel
Mullier, Francois [1 ]
机构
[1] Catholic Univ Louvain, CHU UCL Namur, Namur Res Inst Life Sci NARILIS, Hematol Lab,NTHC, Yvoir, Belgium
[2] Catholic Univ Louvain, CHU UCL Namur, Namur Res Inst Life Sci NARILIS, Hematol Dept,NTHC, Yvoir, Belgium
关键词
Edoxaban; drug measurement; coagulation tests; guidelines; factor Xa inhibitors; FACTOR XA INHIBITOR; EX-VIVO; PROTHROMBIN TIME; ANTI-XA; ANTICOAGULANT ACTIVITY; PLASMA-CONCENTRATIONS; THROMBIN GENERATION; LC-MS/MS; RIVAROXABAN; DABIGATRAN;
D O I
10.1160/TH15-05-0415
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Assessment of plasma concentration/effect of edoxaban may be useful in some situations. Also, clinicians need to know how routine coagulation assays are influenced. It was our aim to determine coagulation tests useful for the assessment of edoxaban's pharmacodynamics and provide recommendations for the interpretation of haemostasis diagnostic tests. Edoxaban was spiked at concentrations ranging from 0 to 1,000 ng/ml in platelet-poor plasma which covers the on-therapy range (from +/- 25 ng/ml at C-trough to +/- 170 ng/ml at C-max). aPTT, PT, dRVVT, chromogenic anti-Xa assays, TGA and a large panel of haemostasis diagnostic tests were performed using several reagents. A concentration-dependent prolongation of aPTT, PT and dRVVT was observed. The effect was dependent on the reagents. FXa chromogenic assays showed high sensitivity and a linear correlation depending on the methodology. TGA may be useful to assess the pharmacodynamics of edoxaban but its turnaround time and the lack of standardisation are limitations. Edoxaban impairs the assessment of lupus anticoagulant, protein S (clotting method), APC-R, antithrombin (FXa-based assay) and measurement of clotting factor activity. Immunological assays and assays acting below the FXa are not influenced by edoxaban. In conclusion, some PT reagents could be used to estimate edoxaban activity. Chromogenic anti-Xa assays are required to assess the plasma concentration. TGA may be useful but requires standardisation. In case of thrombophilia or in the exploration of a haemorrhagic event, immunological assays should be recommended, when applicable. Standardisation of the time between the last intake and the sampling is mandatory to provide a proper assessment of the result.
引用
收藏
页码:368 / 381
页数:14
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