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Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 4, pp 541–548 | Cite as

Comparison of rivaroxaban concentrations between Asians and Caucasians and their correlation with PT/INR

  • Hobart Owen Ng Tsai
  • Janice Jia Ni Goh
  • Jernice Wan Xin Aw
  • Yingying Lin
  • Alan Yean Yip Fong
  • Lee Len Tiong
  • Doreen Su-Yin Tan
Article

Abstract

The objectives of this study are to compare steady-state trough (Cmin,ss) and peak (Cmax,ss) concentrations of rivaroxaban between Asians and Caucasians and to evaluate the relationship between rivaroxaban concentrations and prothrombin time/international normalized ratio (PT/INR). Recruited patients were advised on the time to take rivaroxaban. Cmin,ss and PT/INR were taken when patients arrived. Cmax,ss and PT/INR were drawn between 2 and 4 h later after the patient took rivaroxaban with food. Thirty patients were included in the analyses: 57% (n = 17) males and 43% (n = 13) females, 77% (n = 23) on 20 mg and 23% (n = 7) on 15 mg. Median PTtrough and PTpeak are moderately correlated with Cmin,ss (r2 = 0.43) and Cmax,ss (r2 = 0.49), respectively. Patients on 15 mg have lower Cmin,ss and Cmax,ss versus Caucasians [12 ng/ml vs. 57 ng/ml (Cmin,ss); 87 ng/ml vs. 229 ng/ml (Cmax,ss), p < 0.01 for both]. Patients on 20 mg also have lower Cmin,ss and Cmax,ss versus Caucasians [14 ng/ml vs. 44 ng/ml (Cmin,ss); 101 ng/ml vs. 249 ng/ml (Cmax,ss), p < 0.01 for both]. Subgroup analysis shows patients with BMI ≥ 30 have lower Cmax,ss than patients with BMI < 30 [80.47 ng/ml vs. 124 (p = 0.014)]. Cmin,ss and Cmax,ss were lower in Singaporeans than Caucasians. This may have an impact on the effectiveness of rivaroxaban in Singaporeans. Patients with higher BMI may not benefit similarly as patients with lower BMI. Lastly, the Dade Innovin reagent’s measure of PT/INR is not sensitive towards changes in rivaroxaban concentrations.

Keywords

Rivaroxaban Plasma concentration PT INR Asian 

Notes

Acknowledgements

Dr. Wang Jiexun for her help with the statistics. Dr. Ong Hean Yee, Dr. Lee Chee Wan, Dr. Ling Lee Fong, Dr. Leow Khang Leng, Dr. Dinna Soon Kar Nee, Dr. Michael Liang Mao Chen, Dr. Syed Saqib Imran, Dr. Justin Tang I-Shing, Dr. Cliff Wong Chun Pong, Dr. Ramkumar Sekar for letting us recruit your patients. Ms. Soh Lay See for extending a hand to help us with the logistics of the study.

Funding

This study was funded by National Medical Research Council (NRMC) Centre Grant Pitch-For-Fund. Award No: PFF15001.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

This study was approved by the Domain Specific Review Board (DSRB) prior to the commencement of the study (DSRB approval reference number: 2016/00195).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PharmacyKhoo Teck Puat HospitalSingaporeSingapore
  2. 2.Consultant CardiologistSarawak Heart CentreKota SamarahanMalaysia
  3. 3.Clinical Research Centre, Sarawak General HospitalJalan HospitalKuchingMalaysia

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