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Test Catalog

Test ID: APIXA    
Apixaban, Anti-Xa, Plasma

Useful For Suggests clinical disorders or settings where the test may be helpful

Measuring apixaban concentration in selected clinical situations (eg, renal insufficiency, assessment of compliance, periprocedural measurement of drug concentration, suspected overdose, advanced age, and extremes of body weight)

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Apixaban, an oral anticoagulant that directly inhibits factor Xa, has been approved by the FDA for prophylaxis of thrombosis in atrial fibrillation and surgical patients and treatment of venous thromboembolism (VTE). Unlike warfarin, it does not require routine therapeutic monitoring. However, in selected clinical situations, measurement of drug level would be useful (eg, kidney insufficiency, assessment of compliance, periprocedural measurement of drug concentration, suspected overdose, advanced age, and extremes of body weight).

 

Predicted Apixaban Steady-State Exposure Concentrations(1)

Dosage

Apixaban

C-min (ng/mL)

trough plasma concentration (predose)

Apixaban C-max (ng/mL)

peak plasma concentration
(2-4 hours postdose)

Prevention of VTE: elective hip or knee replacement surgery

 

 

2.5 mg twice daily

51 (23-109)

77 (41-146)

Prevention of stroke and systemic embolism: NVAF

 

 

2.5 mg twice daily

79 (34-162)

123 (69-221)

5 mg twice daily

103 (41-230)

171 (91-321)

Treatment of DVT, treatment of PE and prevention of recurrent DVT and PE (VTE)

 

 

2.5 mg twice daily

32 (11-90)

67 (30-153)

5 mg twice daily

63 (22-177)

132 (59-302)

10 mg twice daily

120 (41-335)

251 (111-572)

 

Median (5th-95th percentile)

VTE-venous thromboembolism, NVAF- nonvalvular atrial fibrillation, DVT-deep vein thrombosis, PE-pulmonary embolism

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

<10 ng/mL

Interpretation Provides information to assist in interpretation of the test results

The lower limit of detection of this assay is 10 ng/mL.

 

Therapeutic reference ranges have not been established. See Clinical Information for peak and trough drug concentrations observed from clinical trials.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Routine monitoring of apixaban is not indicated. Therapeutic reference ranges have not been established, however, peak and trough levels observed in clinical trials at different dosing are available. Apixaban concentration may be affected by drug interactions and liver or renal disease.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Eliquis (apixaban). Package insert. Bristol-Meyers Squibb Company; Revised 11/2019

2. Hurst KV, O'Callaghan JM, Handa A: Quick reference guide to apixaban. Vasc Health Risk Manag. 2017;13:263-267

3. Granger CB, Alexander JH, McMurray JJ, et al: Apixaban versus warfarin in patient with atrial fibrillation. N Engl J Med. 2011 Sep;365(11):981-992

4. Frost C, Nepal S, Wang J, et al: Safety, pharmacokinetics and pharmacodynamics of multiple oral doses of apixaban, a factor Xa inhibitor, in healthy subjects. Br J Clin Pharmocol. 2013 Nov;76:(5):776-786

5. Agnelli G, Buller HR, Cohen A, et al: Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013 Aug 29;369(9):799-808

6. Siegal DM, Curnutte JT, Connolly SJ, et al: Andexanet alfa for reversal of factor Xa inhibitor activity. N Engl J Med. 2015 Dec 17;373:2413-2424

7. Martin K, Beyer-Westendorf J, Davidson BL, Huisman MV, Sandset PM, Moll S: Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the ISTH. J Thromb Haemost. 2016 Jun;14(6):1308-1313

Special Instructions Library of PDFs including pertinent information and forms related to the test