Evaluation of the effect of apixaban using a viscoelastic coagulation assay with Russell’s viper venom reagent

Abstract

Background Conventional coagulation tests, such as prothrombin time and activated partial thromboplastin time, are not sensitive to anticoagulation by apixaban. We evaluated the antithrombotic effect of apixaban using a Russell viper venom (RVV) test for a patient who underwent posterior spine fusion surgery. Case presentation An 84-year-old man was scheduled for percutaneous posterior spine fusion. He continued apixaban until the night before surgery and resumed it on the first day after surgery. We performed an RVV test as point-of-care coagulation monitoring in combination with chromogenic anti-activated factor X (anti-Xa) activity, prothrombin time, and activated partial thromboplastin time. Clotting time with the RVV test was prolonged according to the anti-Xa activity of apixaban, which was in the therapeutic range during surgery. Conclusions An RVV test might be useful as a point-of-care assay for estimation of the anti-Xa level induced by apixaban during the perioperative period.

Low-Molecular-Weight Heparin Resistance and Its Viscoelastic Assessment in Critically Ill COVID-19 Patients

“…A total of 509 anti-Xa peak level measurements within the first 14 days on ICU were analyzed (median of 5 [3][4][5][6][7][8] analyses per patient). One-third of patients were female (n ¼ 30, 33%); in median, patients were 70 (58-75) years old, had a BMI of 28.4 (24.9-32.1) kg/m 2 , and an ICU LOS of 13 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) days; none of them were vaccinated and in-hospital mortality rate was 26.4% (►Table 1).…”

“…17 However, apart from extrinsic and intrinsic activation (EX test and IN test, respectively) with its Russell's viper venom (RVV) test, ClotPro offers a screening/monitoring option for direct factor Xa and thrombin inhibitors (direct oral anticoagulants). 18 19…”

“…17 However, apart from extrinsic and intrinsic activation (EX test and IN test, respectively) with its Russell's viper venom (RVV) test, ClotPro offers a screening/monitoring option for direct factor Xa and thrombin inhibitors (direct oral anticoagulants). 18,19 Statistics SPSS (IBM SPSS Statistics Version 27) was used for statistical analysis. Correlation analyses between the administered enoxaparin doses with resulting peak anti-Xa levels were done using Spearman's rank correlation.…”