Apixaban

Message

This is the Anti-Xa level assay for patients taking apixaban (Eliquis).
Performed in the Hematology Laboratory, x5475
Sample MUSt be drawn to minimum fill line on tube

Test Code

APIX

Alias/See Also

Eliquis

CPT Codes
85520

Preferred Specimen

plasma

Minimum Volume

2.7 mL sodium citrate tube. Sample MUST be drawn to minimum fill line on tube or the sample will be rejected as QNS.

Instructions

Must be collected 3 hours after administration of apixaban and should not be collected from an indwelling line containing any type of heparin.

Transport Container

Light blue top (sodium citrate), 2.7 mL draw

Transport Temperature

Room Temperature

Specimen Stability

refrigerator: 4 hours
frozen at -70 degrees: 6 months

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Grossly hemolyzed, QNS, clotted

Methodology
chromogenic

Setup Schedule

As requested, Monday-Friday between 8:30-4 pm

Limitations

This assay cannot differentiate between different types of heparins and direct oral Xa inhibitors

Reference Range

The expected concentrations of apixaban (Eliquis) are not well known. According to pharmacokinetic modeling, predicted levels are as follows:
Stroke prevention in atrial fibrillation:
2.5mg twice daily:
Range (5^th, 95^th Percentile)
Peak                      69 - 221 ng/mL
Trough                  34 - 162 ng/mL
5mg twice daily:
Range (5^th, 95^th Percentile)
Peak                      91 – 321 ng/mL
Trough                  41 – 230 ng/mL

Treatment or extended treatment of DVT or PE:
2.5mg twice daily:
Range (5^th, 95^th Percentile)
Peak                      30 - 153 ng/mL
Trough                  11 - 90 ng/mL
5mg twice daily:
Range (5^th, 95^th Percentile)
Peak                      59 - 302 ng/mL
Trough                  22 - 177 ng/mL

10mg twice daily:
Range (5^th, 95^th Percentile)
Peak                      111 - 572 ng/mL
Trough                  41 - 335 ng/mL

VTE prophylaxis:

2.5mg twice daily:

Range (5^th, 95^th Percentile)
Peak                      41 - 146 ng/mL
Trough                  23 - 109 ng/mL

Peak apixaban concentration occurs 3 – 4 hours after a dose. Trough concentration occurs just before the next dose is taken. The predicted peak and trough ranges were obtained through communication with Bristol Myers Squibb on 4/4/18.

Clinical Significance

Test the Anti-Xa level of patients taking Apixaban

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.