Article

Direct Oral Anticoagulants Concentration Testing in Clinical Practice for High-Risk Patients with AF

Register or Login to View PDF Permissions
Permissions× For commercial reprint enquiries please contact Springer Healthcare: ReprintsWarehouse@springernature.com.

For permissions and non-commercial reprint enquiries, please visit Copyright.com to start a request.

For author reprints, please email rob.barclay@radcliffe-group.com.
Average (ratings)
No ratings
Your rating
Copyright Statement:

The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content.

Aim: The aim of this study was to analyse the necessary of coagulation tests for AF patients with high cardiovascular risk in clinical practice.

Design and methods: Quantitative, analytic, cross-sectional clinical study, during the period from April 2018 to February 2019, was performed at Pauls Stradins Clinical University Hospital, Cardiology Centre of Latvia. Data were collected on patients with non-valvular AF on anticoagulation therapy for ≥3 months, defined as a high-risk group by CHA22-VASc score. Concentration was measured using anti-Xa assay and indirect thrombin inhibitors assay. Data were analysed using SPSS.

Results: Data were collected on seven patients, of whom 85.7% (n=6) were men; the mean age was 66.3 (SD ± 5.77) years. The mean CHA22-VASc score was 2.86 (SD ± 1.57). The most common comorbidities were arterial hypertension and coronary artery disease (42.86%; n=3), stroke (42.86%; n=3) and diabetes (28.57%; n=2). Rivaroxaban was used by 71.43% of patients. The increased risk of possible drug–drug interactions most frequently occurred with statins (71.43%; n=5), proton pump inhibitors and anti-inflammatory drugs (42.86%; n=3). Two-thirds of the patients were taking ≥1 drug with potential pharmacokinetics interactions increasing the risk of bleeding. The average Cmax drug concentration in blood was lower than expected, reaching 216.28 ng/ml and decreasing about 67.17% within 24 hours.

Conclusion: Rivaroxaban measurements varied from 27 to 407 ng/ml (median value 143.64 ng/ml) within 24 hours. Three patients had higher than expected rivaroxaban levels.