Rivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation

Abstract Peritoneovenous shunts (PVSs) are used to relieve ascites in cirrhosis. Disseminated intervascular coagulation (DIC) is a complication of PVSs requiring immediate PVS removal. We report a patient who developed new elevations of prothrombin time (PT) and activated partial thromboplastin time...

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Autores principales:	Fabienne Lucas, Michael S. Stecker, Olga Pozdnyakova, Jean M. Connors, Elisabeth M. Battinelli
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	blood coagulation disseminated intravascular coagulation liver cirrhosis peritoneovenous shunt rivaroxaban rivaroxaban‐calibrated chromogenic anti‐Xa assay Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/9afc356c520641c987ae8f2e89e4e514
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spelling	oai:doaj.org-article:9afc356c520641c987ae8f2e89e4e5142021-11-29T09:35:28ZRivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation2475-037910.1002/rth2.12594https://doaj.org/article/9afc356c520641c987ae8f2e89e4e5142021-10-01T00:00:00Zhttps://doi.org/10.1002/rth2.12594https://doaj.org/toc/2475-0379Abstract Peritoneovenous shunts (PVSs) are used to relieve ascites in cirrhosis. Disseminated intervascular coagulation (DIC) is a complication of PVSs requiring immediate PVS removal. We report a patient who developed new elevations of prothrombin time (PT) and activated partial thromboplastin time (aPTT) 6 hours after PVS placement, concerning for new‐onset DIC. We address the key clinical question of distinguishing DIC from rivaroxaban effect on labs. The patient took rivaroxaban 3 hours after PVS placement, suggesting rivaroxaban effect. Rivaroxaban‐calibrated anti‐Xa level was in the expected treatment range. Over 12 hours, coagulation labs and rivaroxaban levels declined, with no evidence of DIC. The sudden PT/aPTT increase was attributed to rivaroxaban, however, the distinction between DIC and rivaroxaban effect was possible only with the rapid availability of rivaroxaban levels. While there are no US Food and Drug Administration–approved tests for rivaroxaban levels in the United States, this case demonstrates they can have significant clinical impact, encouraging more widespread adaptation of these assays.Fabienne LucasMichael S. SteckerOlga PozdnyakovaJean M. ConnorsElisabeth M. BattinelliWileyarticleblood coagulationdisseminated intravascular coagulationliver cirrhosisperitoneovenous shuntrivaroxabanrivaroxaban‐calibrated chromogenic anti‐Xa assayDiseases of the blood and blood-forming organsRC633-647.5ENResearch and Practice in Thrombosis and Haemostasis, Vol 5, Iss 7, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	blood coagulation disseminated intravascular coagulation liver cirrhosis peritoneovenous shunt rivaroxaban rivaroxaban‐calibrated chromogenic anti‐Xa assay Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	blood coagulation disseminated intravascular coagulation liver cirrhosis peritoneovenous shunt rivaroxaban rivaroxaban‐calibrated chromogenic anti‐Xa assay Diseases of the blood and blood-forming organs RC633-647.5 Fabienne Lucas Michael S. Stecker Olga Pozdnyakova Jean M. Connors Elisabeth M. Battinelli Rivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation
description	Abstract Peritoneovenous shunts (PVSs) are used to relieve ascites in cirrhosis. Disseminated intervascular coagulation (DIC) is a complication of PVSs requiring immediate PVS removal. We report a patient who developed new elevations of prothrombin time (PT) and activated partial thromboplastin time (aPTT) 6 hours after PVS placement, concerning for new‐onset DIC. We address the key clinical question of distinguishing DIC from rivaroxaban effect on labs. The patient took rivaroxaban 3 hours after PVS placement, suggesting rivaroxaban effect. Rivaroxaban‐calibrated anti‐Xa level was in the expected treatment range. Over 12 hours, coagulation labs and rivaroxaban levels declined, with no evidence of DIC. The sudden PT/aPTT increase was attributed to rivaroxaban, however, the distinction between DIC and rivaroxaban effect was possible only with the rapid availability of rivaroxaban levels. While there are no US Food and Drug Administration–approved tests for rivaroxaban levels in the United States, this case demonstrates they can have significant clinical impact, encouraging more widespread adaptation of these assays.
format	article
author	Fabienne Lucas Michael S. Stecker Olga Pozdnyakova Jean M. Connors Elisabeth M. Battinelli
author_facet	Fabienne Lucas Michael S. Stecker Olga Pozdnyakova Jean M. Connors Elisabeth M. Battinelli
author_sort	Fabienne Lucas
title	Rivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation
title_short	Rivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation
title_full	Rivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation
title_fullStr	Rivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation
title_full_unstemmed	Rivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation
title_sort	rivaroxaban‐calibrated chromogenic anti‐xa assay in cirrhosis: use to rule out disseminated intravascular coagulation
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/9afc356c520641c987ae8f2e89e4e514
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Rivaroxaban‐calibrated chromogenic anti‐Xa assay in cirrhosis: Use to rule out disseminated intravascular coagulation

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