International Normalized Ratio as a Screening Test for Assessment of Anticoagulant Activity for Patients Treated With Rivaroxaban or Apixaban: A Pilot Study

Ofek, Fanny; Barchel, Dana; Perets, Nofar; Ziv‐Baran, Tomer; Mahajna, Ahmad; Filipovich-Rimon, Talia; Garach‐Jehoshua, Osnat; Berlin, Maya; Berkovitch, Matitiahu

doi:10.3389/fphar.2019.01177

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…Although there were no previous studies comparable to this one, the current findings are basically consistent with those in 2 relevant previous studies. 13 , 14 In the study of Kodato et al, a lower INR level was associated with a higher risk of DVT occurrence in patients receiving edoxaban thromboprophylaxis, 13 being similar with our study except ours targeted VTE recurrence. In the study of Ofek et al, there was a strong correlation between INR level and anti-Xa concentrations which is used to monitor DOACs anticuagulation, in patients receiving rivaroxaban for the prevention and treatment of VTE.…”

Section: Discussionsupporting

confidence: 87%

“…A formula by using INR values that estimated the anticoagulant activity of rivaroxaban was developed and then validated. 14 These studies have confirmed that INR has a predictive role for the anticoagulant efficacy in patients who receive DOACs anticoagulation. As such, we hypothesized that maybe INR had certain role in the prediction of VTE recurrence and bleeding for patients with acute VTE who undergo anticoagulation with DOACs.…”

Section: Introductionmentioning

confidence: 75%

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International Normalized Ratio Predicts Recurrence and Bleeding in Patients With Acute Venous Thromboembolism Who Undergo Direct Oral Anticoagulants

Zhao,

Cheng,

Luo

et al. 2024

Clin Appl Thromb Hemost

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Prothrombin time/international normalized ratio (PT/INR) is related to both antithrombotic effect and risk of bleeding. Its role in the prediction of venous thromboembolism (VTE) recurrence and bleeding for patients with acute VTE who undergo direct oral anticoagulants (DOACs) treatment is unclear, despite previous studies revealed some association between them. The predictive efficiency of INR for VTE recurrence and bleeding were analyzed in a retrospective cohort with VTE patients who underwent DOACs treatment. Then its predictive efficiency for VTE recurrence and bleeding were validated in a prospective cohort with the acquired cutoffs range, and compared with anti-Xa level, DASH and VTE-BLEED scores. In the retrospective cohort ( n = 1083), the sensitivity and specificity of INR for the prediction of VTE recurrence were 79.4% and 92.8%, respectively. The area under the curve (AUC) was 0.881 (0.803-0.960)( P = .025). The cutoff value of INR was 0.9. The sensitivity and specificity of INR for the prediction of bleeding were 85.7% and 77.9%, respectively. The AUC was 0.876 (0.786-0.967)( P < .001). The cutoff value of INR was 2.1. In the prospective cohort ( n = 202), the calibration showed that there were 4 (50%) patients with VTE recurrence, 156 (97.5%) patients with non-recurrence and bleeding (non-R&B), and 20 (58.8%) patients with bleeding in the low (INR < 0.9)( n = 8), intermediate (0.9 ≤ INR ≤ 2.1)( n = 160), and high (INR > 2.1)( n = 34) groups, respectively. The baseline PT/INR value at the initiation of DOACs treatment is an independent predictor for VTE recurrence and bleeding in patients with acute VTE who undergo DOACs treatment.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 75%

International Normalized Ratio Predicts Recurrence and Bleeding in Patients With Acute Venous Thromboembolism Who Undergo Direct Oral Anticoagulants

Zhao,

Cheng,

Luo

et al. 2024

Clin Appl Thromb Hemost

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“…However, inter‐device variations in the PT make it difficult to compare among different institutions 29 . The international normalized ratio (INR) refers to the ratio of prothrombin time to the normal prothrombin time 30 and is regarded as an ideal method for judging the anticoagulation effect 31 . It overcomes the variability among different laboratories by thromboplastin sensitivity 32 .…”

Section: Introductionmentioning

confidence: 99%

Effect of an Elevated Preoperative International Normalized Ratio on Transfusion and Complications in Primary Total Hip Arthroplasty with the Enhanced Recovery after Surgery Protocol

Peng

Zeng

et al. 2021

Orthopaedic Surgery

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Objective: To verify whether an elevated preoperative international normalized ratio (INR) increases transfusion and complications independently in primary total hip arthroplasty (THA) with the management of an enhanced recovery after surgery (EARS) protocol. Methods:We retrospectively reviewed the database of adults who underwent primary THA between 2014 and 2018 by the same surgeon. A total of 552 patients were assigned into three groups by preoperative INR class: INR ≤ 0.9, 0.9 < INR < 1.0, and INR ≥ 1.0. We regarded transfusion within 90 days during the same hospitalization as the primary outcome. We also included perioperative blood loss, maximum Hb drop, postoperative anaemia requiring medicine, and length of hospital stay (LOS) during the same hospitalization in the study. Complications and reoperation at 90 days and mortality at 90 days and 12 months were also included in the study. Univariable analyses were utilized to compare baselines and outcomes among the three groups. Multivariate logistic regressions were used to adjust for differences at baseline among the groups.Results: All patients had an INR < 1.5 preoperatively and were managed with the ERAS protocol. Among them, 93 (16.8%) patients had INR ≤ 0.9, 268 (48.6%) patients had 0.9 < INR < 1.0, and 191 (34.6%) patients had INR ≥ 1.0. In the univariable analyses, as the INR increased, the transfusion rates increased from 1.08% for INR ≤ 0.9, to 1.12% for 0.9 < INR < 1.0 and to 5.76% for INR ≥ 1.0 (P < 0.05). The overall complication rate increased from 10.8% for INR ≤ 0.9, to 16.4% for 0.9 < INR < 1.0, and to 22.5% for INR ≥ 1.0 (P < 0.05). The length of stay (LOS) in the INR ≥ 1.0 group was 5.7 AE 2.2 days, which was significantly longer than that in the INR ≤ 0.9 group (4.7 AE 1.6 days, P = 0.000) and 0.9 < INR < 1.0 group (5.1 AE 2.0 days, P = 0.007). No statistical significance was detected among the groups regarding blood loss, maximum Hb drop, or the incidence of postoperative anaemia that required medicine. There was no significant difference in reoperation or mortality among the groups. When controlling for demographic and comorbidity characteristics, there was no statistically significant difference in the odds of transfusion during the same hospitalization or overall complications at 90 days among the groups (P > 0.05). Conclusions: Elevated preoperative INR cannot increase transfusion or complication rates independently in primaryTHA with the management of the ERAS protocol. With the improvement in the ERAS protocol and the use of tranexamic acid (TXA), an INR < 1.5 is still a conventional safe threshold for THA surgery.

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“…Rivaroxaban belongs to a group of medicines called antithrombotic agents. They are used as an inhibitor of factor Xa, which plays a role in blood clotting [ 1 ]. The administration of this novel antithrombotic agent is recommended following the use of anticoagulant drugs, such as warfarin, and it does not require international normalized ratio monitoring [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

The effects of rivaroxaban, an oral anticoagulant, on human IVD primary cultures

et al. 2021

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IntroductionThe present study aimed to investigate the potential effects of rivaroxaban, an oral anticoagulant that inhibits the effects of factor Xa on intact intervertebral disc tissue cells and the extracellular matrix (ECM).Material and methodsRivaroxaban was applied to primary human cell cultures prepared from tissues of the intervertebral disc. Comparative molecular analyses were performed on non-drug-treated control group samples. Descriptive statistics were presented as the mean ± standard deviation. An analysis of variance (ANOVA) test was performed to determine whether there were significant differences in the mean across the groups. When differences across groups were observed, Tukey’s honestly significant difference (HSD) post-hoc test was used for multiple pairwise comparisons. The significance of the obtained data was determined statistically. The alpha (P) significance value was < 0.05.ResultsThe cells in the control group and in the rivaroxaban-treated group were viable, healthy, and proliferated (P < 0.05). However, the expressions of the chondroadherin gene (CHAD), cartilage oligo matrix protein (COMP), matrix metallo proteinase (MMP)-13, and MMP-19 genes were changed (P < 0.05).ConclusionsAlthough rivaroxaban does not suppress cell proliferation due to morphological, biological, and biochemical changes in the intervertebral disc tissue, it may change the expression of genes that are related to ECM maintenance.

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International Normalized Ratio as a Screening Test for Assessment of Anticoagulant Activity for Patients Treated With Rivaroxaban or Apixaban: A Pilot Study

Cited by 5 publications

References 33 publications

International Normalized Ratio Predicts Recurrence and Bleeding in Patients With Acute Venous Thromboembolism Who Undergo Direct Oral Anticoagulants

International Normalized Ratio Predicts Recurrence and Bleeding in Patients With Acute Venous Thromboembolism Who Undergo Direct Oral Anticoagulants

Effect of an Elevated Preoperative International Normalized Ratio on Transfusion and Complications in Primary Total Hip Arthroplasty with the Enhanced Recovery after Surgery Protocol

The effects of rivaroxaban, an oral anticoagulant, on human IVD primary cultures

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