TY - JOUR
T1 - Assessment of low plasma concentrations of apixaban in the periprocedural setting
AU - Lessire, Sarah
AU - Dincq, Anne-Sophie
AU - Siriez, Romain
AU - Pochet, Lionel
AU - Sennesael, Anne-Laure
AU - Vornicu, Ovidiu
AU - Hardy, Michael
AU - Deceuninck, Olivier
AU - Douxfils, Jonathan
AU - Mullier, François
N1 - Funding Information:
S. Lessire and F. Mullier conceptualized and designed the study, participated in the analysis and the interpretation of the data and have written the manuscript. L. Pochet wrote the methodology of the liquid chromatography coupled with tandem mass spectrometry. R. Siriez performed the LC-MS/MS experiments. O. Deceuninck, AS Dincq, S. Lessire, AL Sennesael, and O. Vornicu participated to the patient's recruitment. J. Douxfils wrote a part of the methodology section. All the authors revised the intellectual content of the manuscript and approved its final version. The authors thank Justine Baudar, Maïté Guldenpfennig, Celia Devroye, Christelle Vancrayenest, and Virginie Dubois for their contribution.
Publisher Copyright:
© 2020 John Wiley & Sons Ltd
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Introduction: Estimation of residual apixaban plasma concentrations may be requested in the management of emergencies. This study aims at assessing the performance of specific anti-Xa assays calibrated with apixaban on real-life samples with low apixaban plasma concentrations (<30 ng/mL) and on-treatment ranges, with and without interference of low-molecular-weight heparin (LMWH). Methods: 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 was tested on 134 blood samples, collected from patients on apixaban, wherefrom 74 patients received LMWH after apixaban cessation. The results were compared with the liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) measurements. Results: The Biophen
®DiXaI, Biophen
®DiXaI LOW, and STA
®LAX showed very good correlation with LC-MS/MS measurements in patients without LMWH administration (Spearman r.95,.99, and.98, respectively). Their limits of quantitation were defined at 48, 24, and 12 ng/mL, respectively. The Bland-Altman test measured mean bias (SD) at 5.6 (13.1), −2.5 (5.0), and −0.8 (6.1) ng/ml, respectively. The Spearman r of the Biophen
®DiXaI decreased to 0.64 in presence of low apixaban concentrations. The Spearman r of the Biophen
®DiXaI LOW and STA
®LAX decreased to 0.39 and 0.26, respectively, in presence of LMWH. Conclusions: The accuracy of the low methodologies (Biophen
®DiXaI LOW and STA
®LAX) is slightly improved for low apixaban plasma concentrations, compared with the normal procedure of Biophen
®DiXaI. The interference of LMWH on the low methodologies is measurable, however, less important than the previously reported interference of LMWH on rivaroxaban calibrated specific anti-Xa assays.
AB - Introduction: Estimation of residual apixaban plasma concentrations may be requested in the management of emergencies. This study aims at assessing the performance of specific anti-Xa assays calibrated with apixaban on real-life samples with low apixaban plasma concentrations (<30 ng/mL) and on-treatment ranges, with and without interference of low-molecular-weight heparin (LMWH). Methods: 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 was tested on 134 blood samples, collected from patients on apixaban, wherefrom 74 patients received LMWH after apixaban cessation. The results were compared with the liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) measurements. Results: The Biophen
®DiXaI, Biophen
®DiXaI LOW, and STA
®LAX showed very good correlation with LC-MS/MS measurements in patients without LMWH administration (Spearman r.95,.99, and.98, respectively). Their limits of quantitation were defined at 48, 24, and 12 ng/mL, respectively. The Bland-Altman test measured mean bias (SD) at 5.6 (13.1), −2.5 (5.0), and −0.8 (6.1) ng/ml, respectively. The Spearman r of the Biophen
®DiXaI decreased to 0.64 in presence of low apixaban concentrations. The Spearman r of the Biophen
®DiXaI LOW and STA
®LAX decreased to 0.39 and 0.26, respectively, in presence of LMWH. Conclusions: The accuracy of the low methodologies (Biophen
®DiXaI LOW and STA
®LAX) is slightly improved for low apixaban plasma concentrations, compared with the normal procedure of Biophen
®DiXaI. The interference of LMWH on the low methodologies is measurable, however, less important than the previously reported interference of LMWH on rivaroxaban calibrated specific anti-Xa assays.
KW - anticoagulants
KW - apixaban
KW - drug monitoring
KW - heparin
KW - low-molecular-weight heparin
KW - perioperative
KW - periprocedural
UR - http://www.scopus.com/inward/record.url?scp=85083423471&partnerID=8YFLogxK
UR - https://researchportal.unamur.be/en/publications/assessment-of-low-plasma-concentrations-of-apixaban-in-the-periprocedural-setting(7ef2d3c5-020b-4edc-883b-ae8efb406e99).html
U2 - 10.1111/ijlh.13202
DO - 10.1111/ijlh.13202
M3 - Article
C2 - 32297711
SN - 1751-553X
VL - 42
SP - 394
EP - 402
JO - International Journal of Laboratory Hematology
JF - International Journal of Laboratory Hematology
IS - 4
ER -