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Evaluation of point‐of‐care coagulation tests as alternatives to anti‐Xa activity for monitoring the anticoagulant effects of rivaroxaban in healthy dogs
Author(s) -
Lynch Alex M.,
Ruterbories Laura K.,
Griffith Emily H.,
Hanel Rita M.,
Stablein Alyssa P.,
Brooks Marjory B.
Publication year - 2020
Publication title -
journal of veterinary emergency and critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.886
H-Index - 47
eISSN - 1476-4431
pISSN - 1479-3261
DOI - 10.1111/vec.13011
Subject(s) - rivaroxaban , medicine , partial thromboplastin time , prothrombin time , pharmacodynamics , coagulation testing , anticoagulant , anesthesia , coagulation , lag time , atrial fibrillation , pharmacokinetics , warfarin , biology , biological system
Objective To evaluate a panel of coagulation assays for their potential utility in rivaroxaban monitoring as alternatives to the rivaroxaban‐specific anti‐Xa activity (RIVA). Design Prospective experimental study. Setting University research laboratory. Animals Five healthy neutered male Beagles. Interventions Dogs were administered a median dose of 1.8 mg/kg rivaroxaban (range, 1.6–1.8 mg/kg) orally once daily for 2 consecutive days as part of a pharmacodynamic study. Blood was collected from a preplaced jugular catheter at time points relative to their rivaroxaban administration (0, 2, 4, 8, 24, 36, and 48 h) for measurement of RIVA, prothrombin time (PT), activated partial thromboplastin time, RapidTEG, and thrombin generation variables. Measurements and main results One hundred forty data points were available for analysis. There was poor correlation between RIVA and RapidTEG variables: R time (R) (min) ( r = 0.554, P < 0.0001), K time (K) (min) ( r = –0.204, P = 0.016), alpha angle (degrees) ( r = 0.152, P = 0.073), Maximum amplitude (MA) (mm) ( r = 0.106, P = 0.215), and G value (G) (dynes/s) ( r = 0.108, P = 0.205). A good correlation was noted between thrombin generation variables and RIVA: lag time (min) ( r = 0.827, P < 0.0001), peak (nM) ( r = –0.752, P < 0.0001), and endogenous thrombin potential (nM·min) ( r = –0.762, P < 0.0001). There was an excellent correlation between PT and RIVA ( r = 0.915, P < 0.0001) and a good correlation between activated partial thromboplastin time and RIVA ( r = 0.772, P < 0 .0001). Conclusions Of all the coagulation tests investigated, the PT correlated best with RIVA. There is potential for PT being a convenient second‐line monitoring option in dogs receiving rivaroxaban, but further work is necessary to validate other PT assays. Thromboelastography performed with strong activators correlated poorly with anti‐Xa activity.