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Abstract
BackgroundRivaroxaban is a direct oral anticoagulant designed to dispense with the necessity of laboratory monitoring. However, monitoring rivaroxaban levels is necessary in certain clinical conditions, especially in the critical care setting.MethodsThis is a diagnostic accuracy study evaluating sensitivity and specificity of prothrombin time (PT), activated partial thromboplastin time (aPTT), and Dilute Russell viper venom time (dRVVT), to evaluate the hemorrhagic risk in patients taking rivaroxaban. The study used a convenience sample of 40 clinically stable patients using rivaroxaban to treat deep vein thrombosis or atrial fibrillation admitted in a private hospital in Brazil, compared to a group of 60 healthy controls. The samples from patients were collected two hours after the use of the medication (peak) and two hours before the next dose (trough).ResultsThe correlation with the plasmatic concentration measured by anti-FXa assay was higher for PT and dRVVTS. The PT and aPTT tests presented higher specificity, while dRVVT was 100% sensible.ConclusionsThere was a strong correlation between the tests and the plasma concentration of the drug. Additionally, our results demonstrated the potential use of dRVVT as a screening test in the emergency room and the need of a second test to improve specificity.
Highlights
Rivaroxaban is a direct oral anticoagulant designed to dispense with the necessity of laboratory monitoring
Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) Rivaroxaban concentration < 30 ng/mL was observed in 38/80 samples; < 50 ng/mL, in 46/80; and
Among the direct oral anticoagulants (DOACs), rivaroxaban has been widely used in medical practice, because it dispenses with the necessity of laboratory control in the majority of patients [4, 5, 8]
Summary
Rivaroxaban is a direct oral anticoagulant designed to dispense with the necessity of laboratory monitoring. Rivaroxaban is a direct oral anticoagulant (DOAC) that dispenses with this type of control It is an antithrombotic drug, that acts directly inhibiting activated factor X, impeding the generation of thrombin, and preventing the formation of clots. Rivaroxaban has high bioavailability after oral administration, with a maximum peak of action at around 1.5 to 2 h after use (peak action), a mean half-life of between 5 and 9 h in young patients and 12 to 13 h in those aged over 75 years. It is eliminated in two ways: two thirds are metabolized by the liver (via CYP3A4 and CYP2J2)
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