Albumin and bleed risk in rivaroxaban treated patients

Wojakowski, E.; Cheruvil, C.; Hassan, Amany K.; Holsen, Maya R.; Chen, L.; Rossi, Marianna; Wilcox, N.; Woodruff, Ashley E.

doi:10.1007/s11239-020-02092-w

Cited by 10 publications

(7 citation statements)

References 24 publications

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“…This may probably explain that in our investigation, patients with lower levels of serum albumin concentration were at higher risk of developing ecchymosis when taking rivaroxaban. Our finding was similar to those published investigations, which identified hypoalbuminaemia to be significantly associated with bleeding risk in patients receiving rivaroxaban 20,21 …”

Section: Discussionsupporting

confidence: 93%

“…Our finding was similar to those published investigations, which identified hypoalbuminaemia to be significantly associated with bleeding risk in patients receiving rivaroxaban. 20,21 We explored the impact of medications used before surgery with the potential to influence coagulation function. The pre-surgical protocols of our TKA team chose highly selective inhibitors of cyclooxygenase-2 such as celecoxib and parecoxib over non-selective NSAIDs, which have less risk of increasing the risk of intraoperative bleeding, postoperative bleeding or blood loss 22 as COX-1 dependent platelet aggregation is less influenced.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for ecchymosis in patients receiving rivaroxaban for thromboprophylaxis after total knee arthroplasty: a retrospective cohort study

et al. 2021

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What is known and objective: Ecchymosis of the limb is commonly seen after total knee arthroplasty (TKA) when using anticoagulants for thromboprophylaxis, but it is unknown which factors may predispose patients to an increased risk. The aim of this study was to evaluate risk factors for ecchymosis in patients receiving rivaroxaban after TKA. Methods: A retrospective, single-centre cohort analysis was conducted. The electronic medical records of patients admitted to the Department of Orthopedics during January 2018 to December 2019 and who received rivaroxaban 10 mg daily after TKA were reviewed for documentation of ecchymosis. Baseline demographics, laboratory values and surgical information were included for analysing their relationship with ecchymosis. Results and discussion: A total of 227 patients were included in the study. Among them, 54 patients (23.8%) developed ecchymosis, and 173 did not. The ecchymosis group had a higher proportion of patients with a body weight >60 kg [83.33% vs. 50.00%, p = 0.0004] and hypertension [61.11% vs 41.46%, p = 0.0304]. The ecchymosis group also had a higher BMI [26.04 ± 2.71 kg/m 2 vs 24.52 ± 3.18 kg/m 2 , p = 0.0066] mean arterial pressure (MAP) recorded from post-operation day 1 to day 3 [105.21 mmHg vs 91.52 mmHg, p = 0.0003]. However, serum albumin concentrations before surgery [3.85 g/dL vs. 4.20 g/dL, p = 0.0225] and on post-operation day 3 [3.50 g/dL vs. 3.91 g/dL, p = 0.0370] were lower in the ecchymosis group. Serum haemoglobin on post-operation day 3 was also lower [10.07 g/dL vs. 11.57 g/dL, p = 0.0459]. Five risk factors for ecchymosis were identified by binary logistic regression: mean MAP (from POD1 to POD3) (OR=2.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Risk factors for ecchymosis in patients receiving rivaroxaban for thromboprophylaxis after total knee arthroplasty: a retrospective cohort study

et al. 2021

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“…Additionally, rivaroxaban, apixaban, and P2Y12 inhibitors are all highly protein bound, and lower albumins would result in higher free concentration of drug which may results in more bleeding events [16]. This has been previously established as a risk factor for bleeding events in patients receiving anticoagulant therapy [17][18][19][20]. This data is supported by our results suggesting that higher albumins are protective against bleeding events in patients receiving triple antithrombotic therapy.…”

Section: Discussionsupporting

confidence: 84%

Comparison of bleeding and ischemic events with apixaban vs. rivaroxaban in triple antithrombotic therapy regimens

Chilbert

Woodruff

Saber

et al. 2023

Blood Coagulation &Amp; Fibrinolysis

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Objective To compare the risk of readmissions for major bleeding within one year between apixaban and rivaroxaban as a component of triple antithrombotic therapy. Methods This study was a multicenter, retrospective cohort study conducted at two academic medical centers in the Western New York and New York City region between July 1, 2011 and September 25, 2019. Adult patients were included if they were diagnosed with atrial fibrillation or venous thromboembolism and discharged on new triple antithrombotic therapy. The primary outcome compared the rates of 1-year readmission for major bleeding between apixaban and rivaroxaban groups. Secondary outcomes included rate of ischemic outcomes. Time to event analysis was determined with a Kaplan–Meier plot and Cox proportional hazard ratios (HR). Results A total of 378 patients were included in the study, 212 in the apixaban group and 166 in the rivaroxaban group. Within 1 year, readmission for major bleeding events occurred in six (2.8%) patients in the apixaban group and four (2.4%) patients in the rivaroxaban group (P = 1.000). After adjustment, the major bleeding event rate was not statistically significantly different between apixaban and rivaroxaban [adjusted hazard ratio (aHR) 0.68, 95% confidence interval (CI) 0.12–3.77; P = 0.6624]. Higher albumin levels were identified to be protective against major bleeding related readmission events (aHR 0.18, 95% CI 0.05–0.63; P = 0.0072). The ischemic outcome occurred in seven (3.3%) patients in the apixaban group and three (1.8%) in the rivaroxaban group (P = 0.7368). Conclusion Use of apixaban or rivaroxaban in a triple antithrombotic regimen was not associated with bleeding or ischemic outcomes.

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“…Rivaroxaban is one of the most commonly used drugs to prevent and treat thrombotic diseases [1]. Annually, many patients are candidates for received rivaroxaban for reasons such as atrial fibrillation, cardiac arrhythmia, heart valve disease, thrombophilia, and so on [35].…”

Section: Discussionmentioning

confidence: 99%

Relevance of genetic polymorphisms of the human cytochrome P450 3A4 in rivaroxaban-treated patients

Ercisli¹,

Lechun

Azeez³

et al. 2021

Cell. Mol. Biomed. Rep.

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Rivaroxaban is an anticoagulant drug that prevents forming of blood clots. In addition, it can be administered to prevent and treat thrombotic diseases such as atrial fibrillation, cardiac arrhythmia, heart valve disease, orthopedic surgery, and thrombophilia to reduce the risk of thrombosis. Various factors such as age, gender, diet, medications, and genetic factors effectively determine the dose of rivaroxaban. Genetic variability in drug-metabolizing enzymes, including the cytochrome P450 (CYP450) enzymes and especially CYP3A4, has been associated with rivaroxaban response. The current study aimed to identify the frequency of CYP3A4 common polymorphisms, as well as their association with rivaroxaban response in 100 patients of Arab descent (48.6% female). CYP3A4 gene polymorphisms were examined by the PCR-RFLP method, and the findings were analyzed by SPSS 16 software and t-test. The frequency of CYP3A4*1B/*1B, CYP3A4*1B/*1A, CYP3A4*1B/*1C, and CYP3A4*1A/*1C was 67.35%, 10.64%, 19.12% and 2.89%, respectively. According to our results, CYP3A4 *1B/*1B genotype was the most common, and patients with CYP3A4*1B/*1B alleles needed a higher daily dose of rivaroxaban than *1B/*1A, *1B/*1C, and *1A/*1C carriers (9.57 ± 1.54 mg/day, P=0.015). Therefore, according to the results, CYP3A4 gene polymorphism has an important effect on the dose of rivaroxaban required to maintain the International Normalized Ratio (INR) in the range of 2-3. Article info

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Albumin and bleed risk in rivaroxaban treated patients

Cited by 10 publications

References 24 publications

Risk factors for ecchymosis in patients receiving rivaroxaban for thromboprophylaxis after total knee arthroplasty: a retrospective cohort study

Risk factors for ecchymosis in patients receiving rivaroxaban for thromboprophylaxis after total knee arthroplasty: a retrospective cohort study

Comparison of bleeding and ischemic events with apixaban vs. rivaroxaban in triple antithrombotic therapy regimens

Relevance of genetic polymorphisms of the human cytochrome P450 3A4 in rivaroxaban-treated patients

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