Anti-xa activity and event risk in patients with direct factor xa inhibitors initiated early after stroke

Shinichi Wada, Kazunori Toyoda, Shoichiro Sato, Takayuki Matsuki, Takuya Okata, Masaya Kumamoto, Naoki Tagawa, Manabu Inoue, Akira Okamoto, Masafumi Ihara, Takanari Kitazono, Toshiyuki Miyata, Masatoshi Koga

Research output: Contribution to journalArticle

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Abstract

Background: Measuring anti-Xa activity (AXA) has been reported as useful for predicting future risk of hemorrhagic and ischemic events in stroke patients taking direct factor Xa inhibitors. We evaluated AXA levels of rivaroxaban or apixaban in acute stroke patients with non-valvular atrial fibrillation. Methods and Results: This was a single-center, prospective, observational study. Consecutive patients with acute ischemic stroke or transient ischemic attack who were admitted within 7 days of onset and started taking rivaroxaban or apixaban for NVAF between January 2012 and April 2017 were enrolled. AXA was measured at 2 time points: just before (AXAtrough) and 4 h after (AXApeak) taking rivaroxaban or apixaban on the 2nd day or later of administration. Of 156 patients taking rivaroxaban, hemorrhagic events occurred in 13. Patients with hemorrhagic events had higher AXApeak than those without [median (interquartile range): 1.93 (1.11–3.75) vs. 1.35 (0.80–2.00) IU/mL; P<0.01]. Multivariable-adjusted Cox models showed that AXApeak was independently related to the incidence of hemorrhagic events. Of 169 patients taking apixaban, hemorrhagic events occurred in 11. Patients with hemorrhagic events had higher AXAtrough [2.78 (1.90–3.53) vs. 1.42 (0.93–2.08) IU/mL, P<0.01] and AXApeak [4.05 (3.44–4.72) vs. 2.43 (1.79–3.35) IU/mL, P<0.01] than those without. Both AXAtrough and AXApeak were independently related to the incidence of hemorrhagic events. Conclusions: In these patients who started rivaroxaban or apixaban early after stroke, AXA levels in the early period were related to future hemorrhagic events.

Original languageEnglish
Pages (from-to)2872-2879
Number of pages8
JournalCirculation Journal
Volume82
Issue number11
DOIs
Publication statusPublished - Jan 1 2018

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Stroke
Factor Xa Inhibitors
Transient Ischemic Attack
Incidence
Proportional Hazards Models
Atrial Fibrillation
Observational Studies
apixaban
Rivaroxaban
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Wada, S., Toyoda, K., Sato, S., Matsuki, T., Okata, T., Kumamoto, M., ... Koga, M. (2018). Anti-xa activity and event risk in patients with direct factor xa inhibitors initiated early after stroke. Circulation Journal, 82(11), 2872-2879. https://doi.org/10.1253/circj.CJ-18-0506

Anti-xa activity and event risk in patients with direct factor xa inhibitors initiated early after stroke. / Wada, Shinichi; Toyoda, Kazunori; Sato, Shoichiro; Matsuki, Takayuki; Okata, Takuya; Kumamoto, Masaya; Tagawa, Naoki; Inoue, Manabu; Okamoto, Akira; Ihara, Masafumi; Kitazono, Takanari; Miyata, Toshiyuki; Koga, Masatoshi.

In: Circulation Journal, Vol. 82, No. 11, 01.01.2018, p. 2872-2879.

Research output: Contribution to journalArticle

Wada, S, Toyoda, K, Sato, S, Matsuki, T, Okata, T, Kumamoto, M, Tagawa, N, Inoue, M, Okamoto, A, Ihara, M, Kitazono, T, Miyata, T & Koga, M 2018, 'Anti-xa activity and event risk in patients with direct factor xa inhibitors initiated early after stroke', Circulation Journal, vol. 82, no. 11, pp. 2872-2879. https://doi.org/10.1253/circj.CJ-18-0506
Wada, Shinichi ; Toyoda, Kazunori ; Sato, Shoichiro ; Matsuki, Takayuki ; Okata, Takuya ; Kumamoto, Masaya ; Tagawa, Naoki ; Inoue, Manabu ; Okamoto, Akira ; Ihara, Masafumi ; Kitazono, Takanari ; Miyata, Toshiyuki ; Koga, Masatoshi. / Anti-xa activity and event risk in patients with direct factor xa inhibitors initiated early after stroke. In: Circulation Journal. 2018 ; Vol. 82, No. 11. pp. 2872-2879.
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abstract = "Background: Measuring anti-Xa activity (AXA) has been reported as useful for predicting future risk of hemorrhagic and ischemic events in stroke patients taking direct factor Xa inhibitors. We evaluated AXA levels of rivaroxaban or apixaban in acute stroke patients with non-valvular atrial fibrillation. Methods and Results: This was a single-center, prospective, observational study. Consecutive patients with acute ischemic stroke or transient ischemic attack who were admitted within 7 days of onset and started taking rivaroxaban or apixaban for NVAF between January 2012 and April 2017 were enrolled. AXA was measured at 2 time points: just before (AXAtrough) and 4 h after (AXApeak) taking rivaroxaban or apixaban on the 2nd day or later of administration. Of 156 patients taking rivaroxaban, hemorrhagic events occurred in 13. Patients with hemorrhagic events had higher AXApeak than those without [median (interquartile range): 1.93 (1.11–3.75) vs. 1.35 (0.80–2.00) IU/mL; P<0.01]. Multivariable-adjusted Cox models showed that AXApeak was independently related to the incidence of hemorrhagic events. Of 169 patients taking apixaban, hemorrhagic events occurred in 11. Patients with hemorrhagic events had higher AXAtrough [2.78 (1.90–3.53) vs. 1.42 (0.93–2.08) IU/mL, P<0.01] and AXApeak [4.05 (3.44–4.72) vs. 2.43 (1.79–3.35) IU/mL, P<0.01] than those without. Both AXAtrough and AXApeak were independently related to the incidence of hemorrhagic events. Conclusions: In these patients who started rivaroxaban or apixaban early after stroke, AXA levels in the early period were related to future hemorrhagic events.",
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T1 - Anti-xa activity and event risk in patients with direct factor xa inhibitors initiated early after stroke

AU - Wada, Shinichi

AU - Toyoda, Kazunori

AU - Sato, Shoichiro

AU - Matsuki, Takayuki

AU - Okata, Takuya

AU - Kumamoto, Masaya

AU - Tagawa, Naoki

AU - Inoue, Manabu

AU - Okamoto, Akira

AU - Ihara, Masafumi

AU - Kitazono, Takanari

AU - Miyata, Toshiyuki

AU - Koga, Masatoshi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Measuring anti-Xa activity (AXA) has been reported as useful for predicting future risk of hemorrhagic and ischemic events in stroke patients taking direct factor Xa inhibitors. We evaluated AXA levels of rivaroxaban or apixaban in acute stroke patients with non-valvular atrial fibrillation. Methods and Results: This was a single-center, prospective, observational study. Consecutive patients with acute ischemic stroke or transient ischemic attack who were admitted within 7 days of onset and started taking rivaroxaban or apixaban for NVAF between January 2012 and April 2017 were enrolled. AXA was measured at 2 time points: just before (AXAtrough) and 4 h after (AXApeak) taking rivaroxaban or apixaban on the 2nd day or later of administration. Of 156 patients taking rivaroxaban, hemorrhagic events occurred in 13. Patients with hemorrhagic events had higher AXApeak than those without [median (interquartile range): 1.93 (1.11–3.75) vs. 1.35 (0.80–2.00) IU/mL; P<0.01]. Multivariable-adjusted Cox models showed that AXApeak was independently related to the incidence of hemorrhagic events. Of 169 patients taking apixaban, hemorrhagic events occurred in 11. Patients with hemorrhagic events had higher AXAtrough [2.78 (1.90–3.53) vs. 1.42 (0.93–2.08) IU/mL, P<0.01] and AXApeak [4.05 (3.44–4.72) vs. 2.43 (1.79–3.35) IU/mL, P<0.01] than those without. Both AXAtrough and AXApeak were independently related to the incidence of hemorrhagic events. Conclusions: In these patients who started rivaroxaban or apixaban early after stroke, AXA levels in the early period were related to future hemorrhagic events.

AB - Background: Measuring anti-Xa activity (AXA) has been reported as useful for predicting future risk of hemorrhagic and ischemic events in stroke patients taking direct factor Xa inhibitors. We evaluated AXA levels of rivaroxaban or apixaban in acute stroke patients with non-valvular atrial fibrillation. Methods and Results: This was a single-center, prospective, observational study. Consecutive patients with acute ischemic stroke or transient ischemic attack who were admitted within 7 days of onset and started taking rivaroxaban or apixaban for NVAF between January 2012 and April 2017 were enrolled. AXA was measured at 2 time points: just before (AXAtrough) and 4 h after (AXApeak) taking rivaroxaban or apixaban on the 2nd day or later of administration. Of 156 patients taking rivaroxaban, hemorrhagic events occurred in 13. Patients with hemorrhagic events had higher AXApeak than those without [median (interquartile range): 1.93 (1.11–3.75) vs. 1.35 (0.80–2.00) IU/mL; P<0.01]. Multivariable-adjusted Cox models showed that AXApeak was independently related to the incidence of hemorrhagic events. Of 169 patients taking apixaban, hemorrhagic events occurred in 11. Patients with hemorrhagic events had higher AXAtrough [2.78 (1.90–3.53) vs. 1.42 (0.93–2.08) IU/mL, P<0.01] and AXApeak [4.05 (3.44–4.72) vs. 2.43 (1.79–3.35) IU/mL, P<0.01] than those without. Both AXAtrough and AXApeak were independently related to the incidence of hemorrhagic events. Conclusions: In these patients who started rivaroxaban or apixaban early after stroke, AXA levels in the early period were related to future hemorrhagic events.

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