Journal article
Utilization of anti–factor Xa levels to guide reversal of oral factor Xa inhibitors in the emergency department
American journal of health-system pharmacy, Vol.79(1), pp.e20-e26
08/07/2021
DOI: 10.1093/ajhp/zxab326
PMCID: PMC8385943
PMID: 34363457
Abstract
Abstract Purpose Oral factor Xa inhibitors (FXaIs) are increasingly utilized for outpatient anticoagulation therapy; however, laboratory monitoring is not routinely used to assess the safety and efficacy of these agents. We aimed to evaluate the role of chromogenic anti–factor Xa (anti-Xa) assays in the emergency department (ED) in the setting of patients with an acute bleed or requiring emergent procedures. Methods A retrospective review of anti-Xa levels obtained in the ED between June 1, 2019, and April 30, 2020, was completed. Data were collected to describe the clinical setting of anti-Xa level collection, oral FXaIs used before admission, administration of reversal agents, and patient disposition to further characterize the role of anti-Xa levels in the management of rivaroxaban and apixaban reversal. Results Thirty anti-Xa levels were included in the final analysis. The median time from sample collection to anti-Xa assay result was 45.9 minutes (interquartile range, 35.3-54.7 minutes). Eleven patients (37%) received anticoagulation reversal after their anti-Xa levels were determined. Anticoagulation reversal agents included either activated prothrombin complex concentrates (aPCCs) or prothrombin complex concentrates (PCCs). Anti-Xa levels were collected in 2 patients who had received PCCs before arrival at our ED. Of the patients with anti-Xa levels below 30 ng/mL, none received aPCCs or PCCs after their anti-Xa levels were determined. Anti-Xa assays were used to rule out the presence of FXaIs in 3 patients. Conclusion This study illustrates the novel role of anti-Xa levels in managing patients with an emergent need for reversal in the ED. The assay may be used to rule out the presence of oral FXaIs and avoid unnecessary administrations of anticoagulation reversal agents.
Details
- Title: Subtitle
- Utilization of anti–factor Xa levels to guide reversal of oral factor Xa inhibitors in the emergency department
- Creators
- Anne E Zepeski - University of IowaBrett A Faine - University of IowaAnna E Merrill - University of IowaGrerk Sutamtewagul - University of IowaSharathkumar Bhagavathi - University of Iowa
- Resource Type
- Journal article
- Publication Details
- American journal of health-system pharmacy, Vol.79(1), pp.e20-e26
- DOI
- 10.1093/ajhp/zxab326
- PMID
- 34363457
- PMCID
- PMC8385943
- NLM abbreviation
- Am J Health Syst Pharm
- ISSN
- 1079-2082
- eISSN
- 1535-2900
- Language
- English
- Date published
- 08/07/2021
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Pathology; Emergency Medicine; Pharmacy Practice and Science; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984199921602771
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