A Low Rivaroxaban Plasma Level May Indicate Anticoagulation Undertreatment

  • Simone Lorenzo Romano Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa
  • Paolo Chiarugi Clinical Chemistry Laboratory, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
  • Monica Casini Clinical Chemistry Laboratory, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
  • Giovanni Pellegrini Clinical Chemistry Laboratory, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy
  • Lucia Ruocco Clinical Chemistry Laboratory, Department of Laboratory Medicine, University Hospital of Pisa, Pisa, Italy

Keywords

Rivaroxaban, anti-Xa assays, recurrent venous thrombosis

Abstract

Few reports have been published on the correlation between plasma concentrations of rivaroxaban and clinical outcome in patients who have experienced venous thromboembolism. This article describes the case of a 44-year-old woman who experienced deep vein thrombosis during anticoagulation therapy with rivaroxaban, with evidence of repeated low plasma levels of the drug. We postulate that the determination of plasma rivaroxaban anti-Xa activity can be useful in the evaluation of anticoagulation therapy in selected cases.

References

  • Yaghoubian JM, Adashek J, Yaghoubian-Yazi B, et al. Incomplete resolution of deep vein thromboses during rivaroxaban therapy. Case Rep Cardiol 2017;2017:3628127.

  • Samama MM, Contant G, Spiro TE, Perzborn E, Le Flem L, Guinet C, et al. Laboratory assessment of rivaroxaban: a review. Thromb J 2013;11:11.

  • Louw S, Saragas NP, Ferrao PN, Chirwa TF, Jacobson BF. Correlation between rivaroxaban (Xarelto) plasma activity, patient clinical variables and outcomes in a South African centre. S Afr Med J 2016;106:1017–1020.

  • Reilly PA, Lehr T, Haertter S, Connolly SJ, Yusuf S, Eikelboom JW, et al; RE-LY Investigators. The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation patients: the RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). J Am Coll Cardiol 2014;63:321–328.

  • Testa S, Tripodi A, Legnani C, Pengo V, Abbate R, Dellanoce C, et al; START-Laboratory Register. Plasma levels of direct oral anticoagulants in real life patients with atrial fibrillation: results observed in four anticoagulation clinics. Thromb Res 2016;137:178–183.

  • Eikelboom JW, Quinlan DJ, Hirsh J, Connolly SJ, Weitz JI. Laboratory monitoring of non-vitamin K antagonist oral anticoagulant use in patients with atrial fibrillation: a review. JAMA Cardiol 2017;2:566–574.
  • Published: 2018-10-24

    Issue: Vol 5 No 11 (view)

    Section: Articles

    How to cite:
    Romano, S., Chiarugi, P., Casini, M., Pellegrini, G., & Ruocco, L. (2018). A Low Rivaroxaban Plasma Level May Indicate Anticoagulation Undertreatment. European Journal of Case Reports in Internal Medicine, 5(11). https://doi.org/https://doi.org/10.12890/2018_000937