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In vitro evaluation of anticoagulant therapy management when urgent percutaneous coronary intervention is required in rivaroxaban-treated patients

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Abstract

We investigated in vitro the management of intraprocedural anticoagulation in patients requiring immediate percutaneous coronary intervention (PCI) while using regular direct oral anticoagulants (DOACs). Twenty-five patients taking 20 mg of rivaroxaban once daily comprised the study group, while five healthy volunteers included the control group. In the study group, a beginning (24 h after the last rivaroxaban dose) examination was performed. Then, the effects of basal and four different anticoagulant doses (50 IU/kg unfractionated heparin (UFH), 100 IU/kg UFH, 0.5 mg/kg enoxaparin, and 1 mg/kg enoxaparin) on coagulation parameters were investigated at the 4th and 12th h following rivaroxaban intake. The effects of four different anticoagulant doses were evaluated in the control group. The anticoagulant activity was assessed mainly by anti-factor Xa (anti-Xa) levels. Beginning anti-Xa levels were significantly higher in the study group than in the control group (0.69 ± 0.77 IU/mL vs. 0.20 ± 0.14 IU/mL; p < 0.05). The study group’s 4th and 12th-h anti-Xa levels were significantly higher than the beginning level (1.96 ± 1.35 IU/mL vs. 0.69 ± 0.77 IU/mL; p < 0.001 and 0.94 ± 1.21 IU/mL vs. 0.69 ± 0.77 IU/mL; p < 0.05, respectively). Anti-Xa levels increased significantly in the study group with the addition of UFH and enoxaparin doses at the 4th and 12th h than the beginning (p < 0.001 at all doses). The safest anti-Xa level (from 0.94 ± 1.21 to 2.00 ± 1.02 IU/mL) was achieved 12 h after rivaroxaban with 0.5 mg/kg enoxaparin. Anticoagulant activity was sufficient for urgent PCI at the 4th h after rivaroxaban treatment, and additional anticoagulant administration may not be required at this time. Twelve hours after taking rivaroxaban, administering 0.5 mg/kg of enoxaparin may provide adequate and safe anticoagulant activity for immediate PCI. This experimental study result should confirm with clinical trials (NCT05541757).

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Authors and Affiliations

  1. Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey

    Mehmet Melek, Hasan Ari, Selma Ari, Mehmet Can Cilgin, Mücahit Yarar, Fahriye Vatansever Ağca & Tahsin Bozat

  2. Department of Biochemistry, Bursa Postgraduate Hospital, Bursa, Turkey

    Kagan Huysal

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  1. Mehmet Melek
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  2. Hasan Ari
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  3. Selma Ari
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Contributions

Concept, H.A., M.M., S.A.; design, M.M., H.A., T.B.; supervision, F.V.A., T.B., K.H.; materials, M.C.C., S.A., M.Y.; data collection and/or processing, M.C.C., M.Y., H.A.; analysis and/or interpretation, H.A., M.M., T.B.; literature search, S.A., H.A., F.V.A.; writing, M.M., H.A., S.A.; critical review, H.A., M.M., T.B., K.H. All authors have read and agreed to the published version of the manuscript. The authors declare that all data were generated in-house and that no paper mill was used.

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Correspondence to Hasan Ari.

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Ethical approval

This trial was approved by the Bursa Yuksek Ihtisas Training and Research Hospital, Clinical Research Ethics Committee; 2011-KAEK-25 2021/03-22.

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The authors declare no competing interests.

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Melek, M., Ari, H., Ari, S. et al. In vitro evaluation of anticoagulant therapy management when urgent percutaneous coronary intervention is required in rivaroxaban-treated patients. Naunyn-Schmiedeberg's Arch Pharmacol 396, 3221–3232 (2023). https://doi.org/10.1007/s00210-023-02533-2

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