Measurement of rivaroxaban concentrations demonstrates lack of clinical utility of a PT, dPT and APTT test in estimating levels

Autor:	Henry G. Watson, D. Robertson, I. Thom, Gary A. Cameron
Rok vydání:	2018
Předmět:	medicine.medical_specialty Serial dilution Clinical Biochemistry Urology 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Rivaroxaban Tandem Mass Spectrometry Medicine Humans Poor correlation Prothrombin time medicine.diagnostic_test business.industry Biochemistry (medical) Hematology General Medicine Hplc ms ms 030220 oncology & carcinogenesis Prothrombin Time Partial Thromboplastin Time Blood Coagulation Tests business circulatory and respiratory physiology medicine.drug Factor Xa Inhibitors
Zdroj:	International journal of laboratory hematology. 40(4)
ISSN:	1751-553X
Popis:	INTRODUCTION Rivaroxaban concentrations were measured in 127 inpatient samples using an HPLC-MS/MS assay. METHODS We compared this measurement with a calibrated anti-Xa assay and performed PT, aPTT and dilute PT tests to assess the value of clot-based assays in clinical decision-making. RESULTS The correlation between the anti-Xa assay and the HPLC-MS/MS at therapeutic concentrations was strong (R2 = 0.98). The PT, RecombiPlasTin 2G, and aPTT, Actin FS, showed a linear dose-response but poor correlation (R2 = 0.32 and 0.44, respectively) and at dilutions of 1 in 150 to 1 in 750 the dilute PT assay also showed poor correlation with rivaroxaban concentrations measured by specific assays. A normal PT or aPTT alone did not identify a likely safe rivaroxaban concentration to allow surgery or invasive procedures, but the combination of normal PT and aPTT identified a group of patients with rivaroxaban levels less than 90 ng/mL. Combined normal PT and aPTT had specificity and sensitivity of 0.97 (95% CI 0.92-0.99) and 0.37 (95% CI 0.1-0.74) for a rivaroxaban concentration < 32 ng/mL. CONCLUSIONS The PT and aPTT show poor correlation with rivaroxaban levels measured by calibrated anti-Xa and HPLC-MS/MS assays. A normal combined PT and APTT identified low rivaroxaban levels with high specificity but lacked sensitivity. The dPT assay at several dilutions could not be used to quantify rivaroxaban in clinical samples. The utility of these PT, aPTT and dilute PT assays in a clinical setting is very limited, and results generated must be interpreted with caution.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::933343e066c6310345c2fbe43fe92a92 https://pubmed.ncbi.nlm.nih.gov/29718586 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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