Journal of Thrombosis and Thrombolysis

, Volume 32, Issue 2, pp 183–187 | Cite as

Chromogenic laboratory assays to measure the factor Xa-inhibiting properties of apixaban—an oral, direct and selective factor Xa inhibitor

  • Richard C. Becker
  • Hongqiu Yang
  • Yuchen Barrett
  • Puneet Mohan
  • Jessie Wang
  • Lars Wallentin
  • John H. Alexander
Article

Abstract

An ability to readily determine an anticoagulant effect with an emerging class of direct, active site, oral factor Xa inhibitors is viewed by the medical community as attractive and by some as an absolute requirement for their use in clinical practice. We performed a pharmacokinetic and pharmacodynamic substudy in APPRAISE-1—a study of apixaban in patients with acute coronary syndrome(ACS). A total of 1691 patients had blood sampled for apixaban plasma concentrations using mass spectrometry/high performance liquid chromatography and anti-Xa activity using a chromogenic assay employing either low molecular weight heparin or apixaban as reference standards. Anti-Xa activity, determined by either anti-Xa-LMWH (r = 0.9671; P < 0.0001) or anti-Xa-apixaban (r = 0.9669; P < 0.0001) correlated strongly and in a linear fashion with apixaban plasma concentrations. The correlations for each method were equally strong at low (<100 ng/ml) (r = 0.86, P < 0.0001; r = 0.85, P < 0.0001), intermediate(100–200 ng/ml) (r = 0.73, P < 0.0001; r = 0.69, P < 0.0001) and high (>200 ng/ml) (r = 0.91, P < 0.0001; r = 0.91, P < 0.0001) plasma concentrations of apixaban, respectively. Our pharmacokinetic and pharmacodynamic substudy suggests that an apixaban-mediated anticoagulant effect can be detected even at very low plasma concentrations using a standard laboratory chromogenic anti-Xa assay with either LMWH or apixaban calibrators. While establishing parameters for safety and efficacy will require further investigation, an ability to discern the presence of a drug effect may provide clinically useful information.

Keywords

Apixaban Acute coronary syndrome Ant-Xa activity 

References

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Richard C. Becker
    • 1
  • Hongqiu Yang
    • 1
  • Yuchen Barrett
    • 2
  • Puneet Mohan
    • 2
  • Jessie Wang
    • 2
  • Lars Wallentin
    • 3
  • John H. Alexander
    • 1
  1. 1.Divisions of Cardiology and HematologyDuke University School of Medicine, Duke University Medical Center, Duke Clinical Research InstituteDurhamUSA
  2. 2.Bristol-Meyers SquibbPrincetonUSA
  3. 3.University of Uppsala Clinical Research InstituteUppsalaSweden

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