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An in vitro study to investigate the interference of enoxaparin on plasma levels of direct oral factor Xa inhibitors measured by chromogenic assays
- Source :
- International Journal of Laboratory Hematology
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- Introduction: Co-administration of enoxaparin and a direct oral factor Xa inhibitor (xabans: apixaban, edoxaban, rivaroxaban) could give rise to the problem of overlapping the anti-Xa activity when measuring direct oral anticoagulant (DOAC) levels. We aimed to evaluate in vitro the degree of the interference of increasing enoxaparin concentrations on xaban plasma levels measured by different chromogenic anti-Xa assays with drug-specific calibrators and controls. Methods: Seven plasma samples were spiked with apixaban, edoxaban, or rivaroxaban at fixed concentration, and enoxaparin at increasing concentrations (0, 0.125, 0.250, 0.50, 1.0, 1.50, and 2.0IU/mL). The evaluated chromogenic assays were as follows: Biophen DiXaI and Biophen Heparin LRT (Hyphen BioMed), Berichrom Heparin and Innovance Heparin (Siemens), STA-Liquid Anti-Xa (Stago Diagnostics), Technochrom anti-Xa (Technoclone), and HemosIL Liquid Anti-Xa (Werfen). Results: The presence of enoxaparin caused increased DOAC levels, with over-estimation depending on the anti-Xa assay and on the heparin concentration in the sample. The smallest over-estimation was in the sample with enoxaparin 0.125IU/mL and the greatest in the sample with enoxaparin 2.0IU/mL (0%, 3.1%, and 7.4% vs 583.8%, 526.1%, and 415.2% for apixaban, edoxaban, and rivaroxaban, respectively). Biophen DiXaI showed lower interference compared to other methods (maximum over-estimation in the presence of enoxaparin 2.0IU/mL: 56.4% dosing rivaroxaban by Biophen DIXaI vs 583.8% dosing apixaban by Berichrom Heparin). Conclusion: The presence of enoxaparin interferes with xabans measurement by chromogenic anti-Xa assays causing falsely elevated DOAC levels, the over-estimation being dependent on the anti-Xa assay and on the heparin concentration in the sample.
- Subjects :
- medicine.drug_mechanism_of_action
Clinical Biochemistry
Factor Xa Inhibitor
apixaban
interference
In Vitro Techniques
030204 cardiovascular system & hematology
Pharmacology
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Edoxaban
medicine
Humans
Dosing
rivaroxaban
Rivaroxaban
Chromogenic
business.industry
Biochemistry (medical)
enoxaparin
Original Articles
Hematology
General Medicine
Heparin
Plasma levels
Blood Coagulation Test
chemistry
edoxaban
Original Article
Apixaban
Blood Coagulation Tests
business
Human
Factor Xa Inhibitors
030215 immunology
medicine.drug
Subjects
Details
- ISSN :
- 1751553X and 17515521
- Volume :
- 41
- Database :
- OpenAIRE
- Journal :
- International Journal of Laboratory Hematology
- Accession number :
- edsair.doi.dedup.....4096a5458b0ea27f735d170272c2a9d2