ArticleThrombosis research2020
Apixaban and rivaroxaban anti-Xa level utilization and associated bleeding events within an academic health system.
Article in Thrombosis research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 46 citations in OpenAlex.
- Emergency reversal of Rivaroxaban with Andexanet alfa in a child with hemorrhagic brain metastasis from Wilms tumor.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026Article
- A Single Health System Retrospective Qualitative Analysis of Inpatient Apixaban and Rivaroxaban Calibrated Anti-Xa Level Monitoring and Clinical Implications.Hospital pharmacy · 2026Article
- Direct Oral Anticoagulant Transition Strategies Using Anti-Xa Concentrations Upon Intensive Care Unit Admission.The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians · 2026Article
- Therapeutic Drug Monitoring of Direct Oral Anticoagulants and Its Association with Clinical Outcomes: A Systematic Review and Meta-Analysis.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Peak and Trough Concentration Ranges of Factor Xa Inhibitors for Preventing Thromboembolic Stroke in Korean Patients with Non-valvular Atrial Fibrillation.Annals of laboratory medicine · 2026Article
- Association of Genetic Variants With Rivaroxaban Pharmacokinetics and Pharmacodynamics and Hemorrhage Risk Factors in Patients With Venous Thromboembolism.Journal of the American Heart Association · 2025Observational
- Apixaban dosing in hemodialysis - can drug level monitoring mitigate controversies?BMC nephrology · 2024Article
- Evaluation of Apixaban standard dosing in underweight patients with non-valvular atrial fibrillation: a retrospective cohort study.Thrombosis journal · 2024Article
- Clot time ratio (CTR) and relation to treatment outcome in patients with atrial fibrillation treated with Rivaroxaban.Thrombosis journal · 2024Article
- Anti-coagulant Treatment of Cancer-Associated Thrombosis in Frail Patients: Impact of Frailties on the Management of Drug-Drug Interactions.Clinical pharmacokinetics · 2023Review
- Acute and chronic venous occlusion.The British journal of radiology · 2023Review
- Direct oral anticoagulants or vitamin K antagonists in emergencies: comparison of management in an observational study.Research and practice in thrombosis and haemostasis · 2023Article
- Review
- Comparison of the efficacy and safety of rivaroxaban and low-molecular-weight heparin in Chinese lung cancer patients with nonhigh-risk pulmonary embolism.Thrombosis journal · 2023Article
- When Apixaban and Rivaroxaban Interfere With Anti-Xa Assays: A Cohort Study.Journal of Brown hospital medicine · 2023Article
- Population Pharmacokinetics and Dose Optimization Based on Renal Function of Rivaroxaban in Thai Patients with Non-Valvular Atrial Fibrillation.Pharmaceutics · 2022Article
- Do Apixaban Plasma Levels Relate to Bleeding? The Clinical Outcomes and Predictive Factors for Bleeding in Patients with Non-Valvular Atrial Fibrillation.Biomedicines · 2022Article
- Article
- Apixaban and rivaroxaban anti-Xa level utilization for guidance of administration of andexanet alfa: a case series.Journal of thrombosis and thrombolysis · 2022Article
- A Combined Pharmacometrics Analysis of Biomarker Distribution Under Treatment With Standard- or Low-Dose Rivaroxaban in Real-World Chinese Patients With Nonvalvular Atrial Fibrillation.Frontiers in pharmacology · 2022Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOral factor Xa inhibitors (FXaI) can be administered in fixed doses without the need for routine laboratory monitoring. Anti-Xa assays can estimate anticoagulant effect for specific FXaI's. The aim of this study was to characterize anti-Xa levels in patients taking apixaban or rivaroxaban with major bleeding events.
methodsApixaban and rivaroxaban anti-Xa assays ordered within our hospital system from May 2016 to September 2019 were evaluated. The primary outcome was major bleeding events defined by International Society of Thrombosis and Haemostasis criteria. Median anti-Xa levels for each FXaI were calculated for those with and without major bleeding, as well as those who did and did not receive reversal agents.
resultsA total of 606 anti-Xa levels were analyzed. There were 146 major bleeding events documented, with the most common site being intracranial (63%). Median anti-Xa levels in patients with and without major bleeding were similar, whereas those on apixaban therapy who received reversal agents typically had higher anti-Xa levels (73 ng/mL vs. 153 ng/mL, p = 0.0019). Factors significantly associated with increased odds of bleeding were an age > 80 years, inappropriately high dosing regimens, and modest anti-Xa levels (100-300 ng/mL) for rivaroxaban specifically.
conclusionsOlder age and inappropriately high dosing regimens were associated with major bleeding in patients taking apixaban and rivaroxaban. Further investigation into the utility of anti-Xa levels for FXaI is warranted.
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