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Rivaroxaban
MessageThis is the Anti-Xa assay for patients taking Rivaroxaban (Xarelto).
Performed in the Hematology Laboratory x5475. Sample MUST be drawn to minimum fill line on tube.
Performed in the Hematology Laboratory x5475. Sample MUST be drawn to minimum fill line on tube.
Test Code
RIVA
Alias/See Also
Xarelto
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
Specimen must be collected 3 hours after administration of Rivaroxaban 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 tube
Transport Temperature
Room Temperature
Specimen Stability
Refrigerator: 4 hours
Frozen at -70 degrees C:6 months
Frozen at -70 degrees C:6 months
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Grossly hemolyzed, QNS or clotted
Methodology
Chromogenic
Setup Schedule
As requested. Mon-Friday 8:30-4pm
Limitations
This assay cannot differentiate between different types of heparins and direct oral Xa inhibitors if multiple types are present in the specimen. The cumulative Anti-Xa activity will be measured. Results show no interference with hemoglobin up to 300 mg/dL, triglycerides up to 800 mg/dL, and bilirubin up to 20mg/dL.
Reference Range
Target levels for rivaroxaban (Xarelto) are not well known. According to clinical trials, levels observed were as follows:
10mg once daily dose for VTE prophylaxis:
Range (5th, 95th Percentile)
Peak 91 – 196 ng/mL
Trough 2 – 38 ng/mL
20mg once daily dose for VTE treatment and stroke prevention in atrial fibrillation:
Range (5th, 95th Percentile)
Peak 160 - 360 ng/mL
Trough 4 – 96 ng/mL
Peak rivaroxaban concentration occurs 2 – 4 hours after a dose. Trough concentration occurs just before the next dose is taken. The peak and trough ranges were obtained from the following studies:
Mueck W, Borris LC, Dahl OE et al. Population pharmacokinetics and pharmacodynamics of once- and twice-daily rivaroxaban for the prevention of venous thromboembolism in patients undergoing total hip replacement. Thromb Haemost. 2008 Sep; 100 (3) :453-461.
Buller HR et al. A dose-ranging study evaluating once-daily oral administration of the factor Xa inhibitor rivaroxaban in the treatment of patients with acute symptomatic deep vein thrombosis. The Einstein DVT Dose Ranging Study. Blood 2008; 112:2242-2247.
10mg once daily dose for VTE prophylaxis:
Range (5th, 95th Percentile)
Peak 91 – 196 ng/mL
Trough 2 – 38 ng/mL
20mg once daily dose for VTE treatment and stroke prevention in atrial fibrillation:
Range (5th, 95th Percentile)
Peak 160 - 360 ng/mL
Trough 4 – 96 ng/mL
Peak rivaroxaban concentration occurs 2 – 4 hours after a dose. Trough concentration occurs just before the next dose is taken. The peak and trough ranges were obtained from the following studies:
Mueck W, Borris LC, Dahl OE et al. Population pharmacokinetics and pharmacodynamics of once- and twice-daily rivaroxaban for the prevention of venous thromboembolism in patients undergoing total hip replacement. Thromb Haemost. 2008 Sep; 100 (3) :453-461.
Buller HR et al. A dose-ranging study evaluating once-daily oral administration of the factor Xa inhibitor rivaroxaban in the treatment of patients with acute symptomatic deep vein thrombosis. The Einstein DVT Dose Ranging Study. Blood 2008; 112:2242-2247.
Clinical Significance
Test for the Anti-Xa activity of a patient taking Rivaroxaban.
