Abstract:
INTRODUCTION:Rivaroxaban (RXA) is a direct oral factor Xa (Xa) antagonist with a short half-life and a fast onset and offset of effect. Before elective surgery, discontinuation is recommended with an interval of at least > 24 hours. In clinical practice, this is, however, not always sufficient to achieve a residual RXA plasma concentration deemed appropriate for surgery, defined as ≤ 50 mcg/L. Our study aimed at identifying factors associated with a higher-than-expected residual RXA plasma concentration in a large group of real-life patients. MATERIALS AND METHODS:This retrospective single-centre study included all patients taking RXA between 2012 and 2016 where RXA plasma concentration was determined by pharmacodynamic anti-Xa assay (518 measurements in 368 patients). Medical records were reviewed. Residual RXA plasma concentrations were then compared with expected values according to a pharmacokinetic model. RESULTS:Residual RXA plasma concentration was significantly higher-than-expected in patients with atrial fibrillation, impaired kidney function (glomerular filtration rate [GFR] < 60 mL/min), CYP3A4-, CYP2J2- and PGP-inhibitory co-medication including amiodarone. Impaired kidney function (odds ratio [OR], 2.22, 95% confidence interval [CI], 1.30-3.78, p = 0.003) and concomitant amiodarone intake (OR, 1.97, 95% CI, 1.04-3.72, p = 0.036) were significantly associated with RXA plasma concentrations > 50 mcg/L at 24 to 48 hours after the last RXA intake. CONCLUSION:In our group of real-life patients, impaired kidney function (GFR < 60 mL/min) and co-medication with amiodarone were independently associated with higher-than-expected residual RXA plasma concentrations. In these patients, standard intervals of RXA discontinuation may not always be sufficient before elective surgery and routine pre-operative determination of the residual RXA concentration could be advisable.
journal_name
Thromb Haemostjournal_title
Thrombosis and haemostasisauthors
Kaserer A,Schedler A,Jetter A,Seifert B,Spahn DR,Stein P,Studt JDdoi
10.1055/s-0038-1639585subject
Has Abstractpub_date
2018-05-01 00:00:00pages
808-817issue
5eissn
0340-6245issn
2567-689Xjournal_volume
118pub_type
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:10.1160/TH04-07-0440
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abstract::Treatment of bleeding in patients with Glanzmann's thrombasthenia (GT) can be hampered by iso-antibodies against the αIIbβ3 integrin, which cause rapid clearance of transfused donor platelets. Type 1 GT patients with a total absence of αIIbβ3 from the platelet surface are known to be susceptible to form such isoantibo...
journal_title:Thrombosis and haemostasis
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doi:10.1160/TH15-12-0982
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
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abstract::Carboxypeptidase U (CPU, CPB2, TAFIa) is a basic carboxypeptidase that is able to attenuate fibrinolysis. The inactive precursor procarboxypeptidase U is converted to its active form by thrombin, the thrombin-thrombomodulin complex or plasmin. The aim of this study was to investigate and characterise the time course o...
journal_title:Thrombosis and haemostasis
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doi:10.1160/TH17-02-0097
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章,评审
doi:
更新日期:1977-12-15 00:00:00
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journal_title:Thrombosis and haemostasis
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更新日期:2002-08-01 00:00:00
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journal_title:Thrombosis and haemostasis
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doi:10.1160/TH12-05-0339
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章,评审
doi:10.1160/TH10-03-0195
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1986-12-15 00:00:00
abstract::The mechanism through which the protein kinase Akt (also called PKB), protects the heart against acute ischaemia-reperfusion injury (IRI) is not clear. Here, we investigate whether Akt mediates its cardioprotective effect by modulating mitochondrial morphology. Transfection of HL-1 cardiac cells with constitutively ac...
journal_title:Thrombosis and haemostasis
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doi:10.1160/TH14-07-0592
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1995-11-01 00:00:00
abstract::The effects of etamsylate on human platelet aggregation and ATP release as well as on the arachidonate metabolism by the platelet have been studied. Etamsylate enhanced these platelet functions induced by arachidonic acid (AA), thromboxane A2, collagen and calcium ionophore A23187 but not those induced by ADP and epin...
journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1982-12-27 00:00:00
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:2002-01-01 00:00:00
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1997-10-01 00:00:00
abstract::In 7 healthy volunteers, formation of thrombin (represented by fibrinopeptide A (FPA) generation, alpha-granule release (represented by beta-thromboglobulin [beta TG] release) and the generation of thromboxane B2 (TxB2) were measured in vivo in blood emerging from a template bleeding time incision. At the site of plug...
journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1987-02-03 00:00:00
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1989-09-29 00:00:00
abstract::Interactions between the uPA receptor (uPAR) and various integrins, including alpha(5)beta(1), are known to modulate integrin-dependent cell adhesion, and we have shown that the integrin-associated tetraspanin protein CD82 down-regulates uPAR-dependent plasminogen activation by affecting alpha(5)beta(1) cellular local...
journal_title:Thrombosis and haemostasis
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doi:
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1983-10-31 00:00:00
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1994-07-01 00:00:00
abstract::The Bernard-Soulier syndrome (BSS) is characterized by thrombocytopenia with giant platelets, a prolonged bleeding time with defective platelet adhesion to the subendothelium related to a defect in platelet membrane glycoprotein Ib (GPIb) and a decreased prothrombin consumption. The mechanism of the latter abnormality...
journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1997-02-01 00:00:00
abstract::Chemokines trigger leukocyte trafficking and are implicated in cardiovascular disease pathophysiology. Chemokine-binding proteins, called "Evasins" have been shown to inhibit both CC and CXC chemokine-mediated bioactivities. Here, we investigated whether treatment with Evasin-3 (CXC chemokine inhibitor) and Evasin-4 (...
journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:10.1160/TH13-04-0297
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章,随机对照试验
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更新日期:2017-04-03 00:00:00
abstract:BACKGROUND: Evaluation of thromboembolic risk is essential in anticoagulated atrial fibrillation (AF) patients. The CHA2DS2-VASc score is largely validated and recommended by most guidelines. The GARFIELD-AF Stroke score has been proposed as an alternative risk score. METHODS: We analyzed warfarin-treated patients fro...
journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:10.1055/a-1333-4448
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:10.1160/TH14-12-1073
更新日期:2015-11-01 00:00:00
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:10.1160/TH09-12-0837
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:2003-03-01 00:00:00
abstract::Heparin therapy was monitored with the activated partial thromboplastin time (APTT) and with chromogenic substrate assays (factor Xa and factor IIa inhibition) in 100 plasma samples from 47 patients. Heparin concentrations were classified as being below, within or above a defined therapeutic range (TR; 0.2-0.55 units ...
journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1987-10-28 00:00:00