Abstract Background Apixaban is a factor Xa inhibitor used as a direct oral anticoagulant (DOAC). The laboratory was asked to provide measurements of plasma apixaban in the context of studies regarding interaction of apixaban with other therapeutic drugs. One study involved isolation of plasma from to-be-discarded specimens, where such specimens were those originally collected in mint green-top tubes (Li-heparin tubes containing plasma separator gel), and that had been centrifuged and stored refrigerated for 5 days. Whereas apixaban concentration is known to be stable in refrigerated plasma specimens for up to two weeks, stability of apixaban concentration in plasma stored refrigerated for prolonged periods over plasma separator gel was unknown. Our objective was to examine stability of apixaban in plasma stored refrigerated for 5 days over plasma separator gel. Methods Pharmacy records were reviewed to identify inpatients who were prescribed apixaban, and for whom a mint green-top tube specimen (Becton-Dickinson BD Vacutainer PST Gel and Lithium Heparin, #367961) had been drawn for routine chemistry tests. From such specimens, 500 uL aliquots of plasma were obtained on day 1 (A) and day 5 (B) of storage under refrigeration (4 °C). Apixaban concentrations for A and B were measured by LC-MS/MS and compared. Additionally, short term (1 day) stability of apixaban was examined by comparison of replicate measurements of apixaban in a single spiked pooled purple-top plasma specimen (Becton-Dickinson BD Vacutainer K2 EDTA, #367856), with (C) or without (D) exposure to mint green-top tube separator gel for a 24h refrigeration period. Data analyses were conducted using R (version 4.0.5). Results A total of 21 specimen pairs (A, B) were examined. [Apixaban] ranged from 30-1000 ng/mL. The ratio B/A was 1.007 ± 0.034, consistent with no effect on plasma [apixaban] of refrigerated storage over separator gel between day 1 and day 5 (by paired t-test: p>0.8). Experiments for replicates of (C, D) specimens (n = 4, average [apixaban] = 410 ng/mL) gave D/C ratio of 1.009 ± 0.019, consistent with no effect on plasma [apixaban] of short term (1 day) refrigerated storage of plasma over separator gel (by paired t-test: p>0.4). Conclusions For plasma specimens collected and centrifuged in mint-green plasma separator tubes, there was no effect on plasma [apixaban] of refrigerated storage over separator gel for periods of 0-5 days.
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