Influence of apixaban on commonly used coagulation assays: results from the Belgian national External Quality Assessment Scheme

• Published in: International journal of laboratory hematology Vol. 39; no. 4; pp. 402 - 408
• Main Authors: Van Blerk, M., Bailleul, E., Chatelain, B., Demulder, A., Devreese, K., Douxfils, J., Jacquemin, M., Jochmans, K., Mullier, F., Wijns, W., China, B., Vernelen, K., Soumali, M. R.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.08.2017
• Subjects: Antithrombin; Antithrombins - blood; apixaban; Belgium; Blood Coagulation - drug effects; Blood Coagulation Tests - methods; Blood Coagulation Tests - standards; Clotting; Coagulation; direct oral anticoagulants; Drug Monitoring; external quality assessment; Factor Xa Inhibitors - pharmacology; Factor Xa Inhibitors - therapeutic use; Fibrinogen; Fibrinogen - biosynthesis; Humans; Laboratories; Partial Thromboplastin Time; Prothrombin; Prothrombin Time; Pyrazoles - pharmacology; Pyrazoles - therapeutic use; Pyridones - pharmacology; Pyridones - therapeutic use; Quality Assurance, Health Care; Quality control; routine coagulation assays; Thromboplastin; antithrombin; direct oral anticoagulants; routine coagulation assays; external quality assessment; apixaban
• ISSN: 1751-5521; 1751-553X
• DOI: 10.1111/ijlh.12640

Summary Introduction The Belgian national External Quality Assessment Scheme performed a survey to assess the effect of the direct oral anticoagulant apixaban on the coagulation assays prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and antithrombin as performed with a large number of reagent/instrument combinations. Methods Four lyophilized plasma samples spiked with apixaban (0, 41, 94 and 225 ng/mL) were sent to the 195 Belgian and Luxembourg clinical laboratories performing coagulation testing. Results PT and aPTT were barely influenced at the concentrations tested. At 225 ng/mL apixaban, PT and aPTT clotting times were only 1.15 times longer than at 0 ng/mL. Among PT reagents, RecombiPlasTin 2G® showed a slightly higher sensitivity with 225 ng/mL apixaban prolonging the PT clotting time 1.3‐fold. Among aPTT reagents, there was no appreciable difference in sensitivity. Fibrinogen results were unaffected by the presence of apixaban, but antithrombin activity was considerably overestimated when measured with a FXa‐based assay. At 225 ng/mL apixaban, the median percentage increase in antithrombin level was 31% when measured with the Liquid Antithrombin® reagent and 44% with the Innovance Antithrombin® reagent. Conclusion Our data provide clinical laboratories with useful information on the impact of apixaban on their routine coagulation assays.