Abstract Number: PB0667
Meeting: ISTH 2021 Congress
Background: The purpose of this study was to investigate the anticoagulant effects of currently available oral Anti-Xa agents such as Apixaban, Betrixaban, Edoxaban, and Rivaroxaban and their relative neutralization by AA in terms of such thromboelastographic parameters as R, K, Angle and MA.
Aims: Analysis was carried out in whole blood using thromboelastography (TEG) using the TEG 5000 Hemostasis System (Haemonetics Corp, Massachusetts).
Methods: Blood was drawn from healthy donors in individual groups (n=5-10) into 3.2% citrated tubes. In the TEG cup for testing, 0.2 M CaCl2, saline (with a filler and control), each of the individual FXa Inhibitors at a final concentration (FC) of 1 ug/mL, AA at FC of both 100 ug/mL and 50 ug/mL were tested. TEG parameters such as R-time, K-time, angle and MA were measured.
Results: Edoxaban showed the strongest anticoagulant effects in both R and K time followed by Betrixaban, then Rivaroxaban which were very similar in their anticoagulant effects, with Apixaban showing the weakest anticoagulant effect. Andexanet alpha produced varying levels of neutralization of the anti-Xa agents which are tabulated on Table 1.
Conclusions: All of the four anti-Xa agents produced measurable anticoagulant activities at 1 ug/mL as measured by the TEG parameters. Edoxaban exhibited the strongest anticoagulant effect followed by Betrixaban and Rivaroxaban whereas Apixaban showed much weaker anticoagulant effects. AA FC=100 ug/mL showed much stronger, consistent, and complete neutralization effects of all of the 4 FXa Inhibitors when compared to AA at FC=50 ug/mL. These results strongly suggest that regardless of the variable anticoagulant effect exhibited by the FXa Inhibitors, AA at FC=100ug/mL fully neutralized the anticoagulant effects of this agent as measured by the TEG parameters. AA is shown to be the most effective in neutralizing Betrixaban in R-Time and K-Time at both concentrations. AA was seen to neutralize Apixaban the least.
To cite this abstract in AMA style:Mehrotra S, Hoppensteadt D, Jeske W, Iqbal O, Tafur A, Lewis B, Fareed J. Differential Neutralization of Apixaban, Betrixaban, Edoxaban, and Rivaroxaban by Andexanet Alfa as measured by Whole Blood Thromboelastographic Analysis [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/differential-neutralization-of-apixaban-betrixaban-edoxaban-and-rivaroxaban-by-andexanet-alfa-as-measured-by-whole-blood-thromboelastographic-analysis/. Accessed September 24, 2021.
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