Evaluation of the effect of apixaban using a viscoelastic coagulation assay with Russell\u2019s viper venom reagent

Kaoru Suzuki,Shoichi Uezono,Yoshihiro Kimura,Takako Terui,Nobuyuki Katori,Shunsuke Kobayashi,Hiroshi Sunaga

doi:10.1186/s40981-021-00445-9

Kaoru Suzuki, Shoichi Uezono + Show 5 more

Open Access

https://doi.org/10.1186/s40981-021-00445-9

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Journal: JA clinical reports	Publication Date: May 6, 2021
Citations: 3	License type: open-access

Affiliation: Jikei University School of Medicine

Abstract

BackgroundConventional coagulation tests, such as prothrombin time and activated partial thromboplastin time, are not sensitive to anticoagulation by apixaban. We evaluated the antithrombotic effect of apixaban using a Russell viper venom (RVV) test for a patient who underwent posterior spine fusion surgery.Case presentationAn 84-year-old man was scheduled for percutaneous posterior spine fusion. He continued apixaban until the night before surgery and resumed it on the first day after surgery. We performed an RVV test as point-of-care coagulation monitoring in combination with chromogenic anti-activated factor X (anti-Xa) activity, prothrombin time, and activated partial thromboplastin time. Clotting time with the RVV test was prolonged according to the anti-Xa activity of apixaban, which was in the therapeutic range during surgery.ConclusionsAn RVV test might be useful as a point-of-care assay for estimation of the anti-Xa level induced by apixaban during the perioperative period.

Highlights

Conventional coagulation tests, such as prothrombin time and activated partial thromboplastin time, are not sensitive to anticoagulation by apixaban
An Russell viper venom (RVV) test might be useful as a point-of-care assay for estimation of the anti-Activated factor X (Xa) level induced by apixaban during the perioperative period
prothrombin time (PT) and activated partial thromboplastin time (APTT) are the conventional coagulation tests used for the monitoring of anticoagulant drugs, such as warfarin and heparin, these tests are not sensitive to direct oral anti-activated factor X drugs such as apixaban [1]

Summary

Introduction

Conventional coagulation tests, such as prothrombin time and activated partial thromboplastin time, are not sensitive to anticoagulation by apixaban. Conclusions: An RVV test might be useful as a point-of-care assay for estimation of the anti-Xa level induced by apixaban during the perioperative period. We evaluated the antithrombotic effect of apixaban using ClotPro and RRV for a patient who underwent posterior spine fusion surgery.

Results

Conclusion