Macedo Kelly A, Tatarian Peter, Eugenio Kenneth R
1 St. Luke's Hospital, New Bedford, MA, USA.
2 Southcoast Health, New Bedford, MA, USA.
Ann Pharmacother. 2018 Feb;52(2):154-159. doi: 10.1177/1060028017729481. Epub 2017 Sep 1.
Unanticipated drug-laboratory interactions may occur between direct oral anticoagulants (DOACs) and anti-factor Xa (AXA) levels used to monitor parenteral heparin infusions. Characterization of the extent and duration of DOAC effect on AXA levels may reduce complications with transition to heparin infusions.
To evaluate the impact of oral factor Xa inhibitors on AXA levels with and without concurrent heparin.
This retrospective descriptive study was approved by institutional review board waiver and included patients with AXA levels drawn on a heparin calibrated assay who had received a factor Xa inhibitor. Participants were divided on the basis of whether AXA levels were drawn with concurrent parenteral heparin. If transitioned to heparin, number of AXA draws required until AXA level was within therapeutic range was recorded.
A total of 50 patients (60% rivaroxaban, 40% apixaban) met inclusion criteria. When AXA levels were drawn within 12 hours of apixaban without concurrent heparin (n = 7), 71% were greater than 1 IU/mL, and 29% were below suggested trough levels (0.7-1.1 IU/mL). For AXA levels drawn within 24 hours of rivaroxaban without concurrent heparin (n = 11), 55% were greater than 1 IU/mL, 9% were within suggested trough (0.6-1 IU/mL), and 36% were below 0.6 IU/mL. In patients (n = 28) who were initiated on heparin infusion prior to AXA monitoring, administration of the DOAC within the prior 72 hours resulted in supratherapeutic initial AXA levels 69% of the time.
DOACs may cause elevations in heparin-calibrated AXA assays; this creates problematic challenges in using the AXA level to optimize heparin management.
直接口服抗凝剂（DOACs）与用于监测胃肠外肝素输注的抗Xa因子（AXA）水平之间可能发生意外的药物 - 实验室相互作用。表征DOAC对AXA水平影响的程度和持续时间可能会减少向肝素输注过渡时的并发症。
评估口服Xa因子抑制剂在有或无同时使用肝素情况下对AXA水平的影响。
这项回顾性描述性研究经机构审查委员会豁免批准，纳入了接受Xa因子抑制剂治疗且AXA水平通过肝素校准测定法测定的患者。参与者根据AXA水平测定时是否同时使用胃肠外肝素进行分组。如果过渡到肝素治疗，则记录在AXA水平达到治疗范围之前所需的AXA检测次数。
共有50名患者（60%使用利伐沙班，40%使用阿哌沙班）符合纳入标准。在未同时使用肝素的情况下，于阿哌沙班用药后12小时内测定AXA水平（n = 7）时，71%的水平大于1 IU/mL，29%低于建议的谷值水平（0.7 - 1.1 IU/mL）。在未同时使用肝素的情况下，于利伐沙班用药后24小时内测定AXA水平（n = 11）时，55%的水平大于1 IU/mL，9%在建议的谷值范围内（0.6 - 1 IU/mL），36%低于0.6 IU/mL。在AXA监测前开始肝素输注的患者（n = 28）中，在之前72小时内使用DOAC导致69%的患者初始AXA水平高于治疗范围。
DOACs可能导致肝素校准的AXA测定值升高；这在利用AXA水平优化肝素管理方面带来了问题和挑战。
