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Published on: October 12, 2012
Evaluation of the effect of apixaban using a viscoelastic coagulation assay with Russell's viper venom reagent
Kaoru Suzuki1, Nobuyuki Katori2, Yoshihiro Kimura1
1Department of Anesthesiology, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
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.
Insights
The Russell viper venom (RVV) test effectively monitored apixaban (a direct oral anticoagulant) levels during spine surgery. This point-of-care test showed promise for perioperative anticoagulation management.
Area of Science:
- Pharmacology and Toxicology
- Cardiovascular Medicine
- Surgical Anesthesiology
Background:
- Conventional coagulation tests (prothrombin time, activated partial thromboplastin time) lack sensitivity to direct oral anticoagulants like apixaban.
- Effective perioperative anticoagulation management is crucial for patients undergoing major surgery, such as posterior spine fusion.
- Apixaban is a commonly prescribed anticoagulant requiring reliable monitoring methods, especially around surgical procedures.
Purpose of the Study:
- To evaluate the utility of the Russell viper venom (RVV) test for monitoring the antithrombotic effect of apixaban.
- To assess apixaban's anticoagulant activity in a patient undergoing posterior spine fusion surgery using point-of-care testing.
Main Methods:
- A case study involving an 84-year-old male patient scheduled for percutaneous posterior spine fusion.
- Apixaban administration was managed perioperatively (discontinued before surgery, resumed after).
- Point-of-care monitoring included the RVV test, chromogenic anti-factor Xa (anti-Xa) activity, prothrombin time, and activated partial thromboplastin time.
Main Results:
- The RVV test demonstrated prolonged clotting times that correlated with apixaban's anti-Xa activity.
- Apixaban levels, as indicated by the RVV test and anti-Xa activity, were within the therapeutic range during the surgical procedure.
- Conventional coagulation tests did not adequately reflect the degree of anticoagulation by apixaban.
Conclusions:
- The Russell viper venom (RVV) test shows potential as a valuable point-of-care assay for estimating apixaban's anti-Xa levels.
- This method could aid in managing apixaban during the perioperative period, ensuring adequate anticoagulation and minimizing bleeding risk.
- Further studies are warranted to validate the RVV test's role in routine clinical practice for apixaban monitoring.
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