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HelpTest Code APIXA Apixaban, Anti-Xa, Plasma
Ordering Guidance
This assay is not indicated for monitoring low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) concentrations. The presence of UFH and LMWH will cause the apixaban anti-Xa level to be falsely elevated.
This assay is optimized to measure apixaban concentration in presence of coagulation factor Xa recombinant, inactivated-zhzo (andexanet alfa, Andexxa).
Necessary Information
Specimen Required
Specimen Type: Platelet-poor plasma
Collection Container/Tube: Light-blue top (3.2% sodium citrate)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Specimen should be collected 2 to 4 hours (peak) after a dose or just prior (trough) to the next dose for apixaban concentrations.
2. For complete instructions, see Coagulation Guidelines for Specimen Handling and Processing.
3. Centrifuge, transfer all plasma into a plastic vial, and centrifuge plasma again.
4. Aliquot plasma into a plastic vial leaving 0.25 mL in the bottom of centrifuged vial.
5. Freeze plasma immediately (no longer than 4 hours after collection) at -20° C or, ideally, ≤-40° C.
Additional Information:
1. A double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.
2. Each coagulation assay requested should have its own vial.
Forms
If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) with the specimen.
Useful For
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)
Special Instructions
Method Name
Chromogenic Assay
Reporting Name
Apixaban, Anti-Xa, PSpecimen Type
Plasma Na CitSpecimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma Na Cit | Frozen | 42 days |
Reject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.Clinical Information
Apixaban, an oral anticoagulant that directly inhibits factor Xa, has been approved by the US Food and Drug Administration 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, renal insufficiency, assessment of compliance, periprocedural measurement of drug concentration, suspected overdose, advanced age, and extremes of body weight).
Table. 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 |
|
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)
Abbreviations not previously defined:
Nonvalvular atrial fibrillation (NVAF)
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)
Reference Values
An interpretive report will be provided.
Day(s) Performed
Monday through Friday
Report Available
1 to 3 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester