Use of heparin-calibrated anti-Xa assay for apixaban and rivaroxaban measurement in the context of regional telestroke activity
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2023
- ISIDORE Id: 10670/1.b26231...
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Thrombosis--Chemotherapy Thrombolysis Fibrinolytic therapyCiter ce document
Céline Delassasseigne et al., « Use of heparin-calibrated anti-Xa assay for apixaban and rivaroxaban measurement in the context of regional telestroke activity », Annales de Biologie Clinique, ID : 10670/1.b26231...
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Introduction: In Bordeaux University Hospital, neurologists are required to prescribe thrombolysis using telemedicine (telethrombolysis) for anticoagulated stroke patients admitted to peripheral centers in the Nouvelle-Aquitaine region. However, due to the bleeding risk, the maximum concentration of direct oral anticoagulants (DOACs) for authorizing thrombolysis is 30, 50, or 100 ng/mL (depending on the sources and the patient-specific benefit-risk ratio). Most of the time, specific assays of DOACs are not available in these peripheral centers. We therefore studied an alternative test: the unfractionated heparin (UFH) anti-Xa activity, which is available in most laboratories and could be used to estimate the DOAC concentration. Methods: Five centers were included in our study: three centers using Werfen’s Liquid Anti-Xa HemosIL® reagent and two centers using Stago’s STA-Liquid Anti-Xa® reagent. For each reagent, we established correlation curves between DOAC and UFH anti-Xa activities and determined UFH cut-offs for the thresholds of 30, 50, and 100 ng/mL respectively. Results: A total of 1,455 plasmas were tested. There was an excellent correlation between DOAC and UFH anti-Xa activities using a third-degree modeling curve, regardless of the reagent used. However, significant inter-reagent variability was observed when it came to the obtained cut-offs. Conclusion: Our study shows that it is unsuitable to use a universal cut-off. In opposition to recommendations made by other publications, UFH cut-offs must be adapted to the reagent used locally by the laboratory, and to the considered DOAC.
