Coagulation assays in a case of apixaban overdose

Coagulation assays in a case of apixaban overdose Intentional overdose of apixaban is rare and minimal data exist regarding the usefulness of routinely available laboratory tests to predict drug levels. A 50-year-old man was admitted after ingestion of 200-mg apixaban. Serial blood samples were obtained over a 54-h period for assessment of the fall-off in drug levels using the prothrombin time/international normalized ratio and anti-Xa assays and compared with an apixaban-specific chromogenic assay. The prothrombin time/international normalized ratio and anti-Xa assays correlated with the apixaban level when the drug was in the supratherapeutic range (>130 ng/ml) but not in the typical therapeutic trough to peak levels. Apixaban levels are best assessed by a specific anti-Xa test using optimized chromogenic substrates and specific calibrators. A standard anti-Xa test can be a useful surrogate when drug levels are high but use of a specific threshold level for discharge purposes requires caution. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Blood Coagulation & Fibrinolysis Wolters Kluwer Health

Coagulation assays in a case of apixaban overdose

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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
0957-5235
eISSN
1473-5733
D.O.I.
10.1097/MBC.0000000000000706
Publisher site
See Article on Publisher Site

Abstract

Intentional overdose of apixaban is rare and minimal data exist regarding the usefulness of routinely available laboratory tests to predict drug levels. A 50-year-old man was admitted after ingestion of 200-mg apixaban. Serial blood samples were obtained over a 54-h period for assessment of the fall-off in drug levels using the prothrombin time/international normalized ratio and anti-Xa assays and compared with an apixaban-specific chromogenic assay. The prothrombin time/international normalized ratio and anti-Xa assays correlated with the apixaban level when the drug was in the supratherapeutic range (>130 ng/ml) but not in the typical therapeutic trough to peak levels. Apixaban levels are best assessed by a specific anti-Xa test using optimized chromogenic substrates and specific calibrators. A standard anti-Xa test can be a useful surrogate when drug levels are high but use of a specific threshold level for discharge purposes requires caution.

Journal

Blood Coagulation & FibrinolysisWolters Kluwer Health

Published: Mar 1, 2018

References

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