Test Background Apixaban is a direct oral anticoagulant (DOAC) which exerts its anticoagulant effect through its ability to directly inhibit Coagulation Factor X. Plasma Apixaban levels are measured in mass concentration by chromogenic anti-Xa assay using drug-specific calibrators.
Recommended as an option for (NICE Guidelines 2016 – KTT16)
• Prevention of VTE after elective hip or knee replacement
• Treatment and secondary prevention of DVT and/or PE
• Prevention of stroke and systemic embolism in people with non-valvular AF
DOAC monitoring is not generally required; however measurement may be useful where clearance is compromised or where patients are actively bleeding.
BCSH Guidelines (2014) Measurement of non-coumarin anticoagulants and their effects on tests of Haemostasis:
Dose Peak (mean and range) Trough (mean and range)
Apixaban 2.5 mg bd 62 ng/mL (CV 37%) 21 ng/mL (CV 17%)
Apixaban 5 mg bd 128 ng/mL (CV 10%) 50 ng/mL (CV 20%)
Sample Required 4.5 mL sodium citrate (pale blue top) adults 1.8 mL sodium citrate (pale blue top) paediatrics
Turnaround Time <24 hours (core hours)
Notes Please Note: Samples will be rejected if under/over-filled, clotted or haemolysed