Effects of Rivaroxaban on Coagulation Assays in Patients with Small Pulmonary Embolism and Deep Vein Thrombosis in Relation to Body Mass Index

Document Type : Original Article

Authors

1 MD, Faculty of Medicine, Mashhad Medical Sciences Branch,Islamic Azad University, Mashhad, Iran

2 Cardiologist, Department of cardiology, Mashhad Medical Sciences Branch,Islamic Azad University, Mashhad, Iran

3 Cardiologist, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Rivaroxaban is a new anticoagulant medication for pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT). There are limited data on the effect of body mass index (BMI) on the pharmacokinetics of rivaroxaban. This study aimed to assess the effect of rivaroxaban on coagulation assays in relation to BMI in PTE and DVT patients.
Materials and Methods: the present cohort studywas conducted on patients with DVT and PTE who were planned to receive rivaroxaban (15 mg bid). Demographic characteristics, as well as anthropometric measurements, were recorded before the rivaroxaban administration. Prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR) were measured before and after 4-6 days of treatment with rivaroxaban. The data were analyzed using paired t-test and analysis of covariance in SPSS software, version 20 (IBM Inc., Chicago, Il, USA)
Results: This study was carried out on 100subjects (i.e., 45 males and 55 females) with the mean age of 38.8±1.7 years. The majority of the subjects (68%) had normal creatinine clearance. The results of the research revealed a significant increase in PT, PT, and INR after the administration of rivaroxaban in both normal-weight and obese subjects (P40 years), gender, and creatinine clearance (i.e., normal and abnormal) groups (P Conclusion: The findings of this study indicated a significant increase in coagulation assays in both normal weight and obese subjects; however, the final PT increment was reduced by BMI.

Keywords

References

  1. References

    1. Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015; 12:464-74.
    2. Bĕlohlávek J, Dytrych V, Linhart A. Pulmonary embolism, part I: epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol. 2013; 18:129-38.
    3. Scheres LJ, Lijfering WM, Cannegieter SC. Current and future burden of venous thrombosis: not simply predictable. Res Pract Thromb Haemost. 2018; 17:199-208. 
    4. Becattini C, Agnelli G. Treatment of venous thromboembolism with new anticoagulant agents. J Am Coll Cardiol. 2016; 67:1941-55.
    5. Schulman S, Ageno W, Konstantinides SV. Venous thromboembolism: past, present and future. Thromb Haemost. 2017; 117:1219-29.
    6. Rechenmacher SJ, Fang JC. Bridging anticoagulation: primum non nocere. J Am Coll Cardiol. 2015; 66:1392-403.
    7. Weitz JI, Semchuk W, Turpie AG, Fisher WD, Kong C, Ciaccia A, et al. Trends in prescribing oral anticoagulants in Canada, 2008-2014. Clin Ther. 2015; 37:2506-14.
    8. Mueck KM, Putnam LR, Anderson KT, Lally KP, Tsao K, Kao LS. Does compliance with antibiotic prophylaxis in pediatric simple appendicitis matter? J Surg Res. 2017; 216:1-8.
    9. Weinz C, Schwarz T, Kubitza D, Mueck W, Lang D. Metabolism and excretion of rivaroxaban, an oral, direct factor Xa inhibitor, in rats, dogs, and humans. Drug Metab Dispos. 2009; 37:1056-64. 
    10. Perzborn E, Roehrig S, Straub A, Kubitza D, Mueck W, Laux V. Rivaroxaban: a new oral factor Xa inhibitor. Arterioscler Thromb Vasc Biol. 2010; 30:376-81.
    11. Cuker A, Siegal DM, Crowther MA, Garcia DA. Laboratory measurement of the anticoagulant activity of the non–vitamin K oral anticoagulants. J Am Coll Cardiol. 2014; 64:1128-39.
    12. van Veen JJ, Smith J, Kitchen S, Makris M. Normal prothrombin time in the presence of therapeutic levels of rivaroxaban. Br J Haematol. 2013; 160:859-61.
    13. Samama MM, Martinoli JL, LeFlem L, Guinet C, Plu-Bureau G, Depasse F, et al. Assessment of laboratory assays to measure rivaroxaban–an oral, direct factor Xa inhibitor. Thromb Haemost. 2010; 103:815-25.
    14. Pan S, Zhu L, Chen M, Xia P, Zhou Q. Weight-based dosing in medication use: what should we know? Patient Prefer Adherence. 2016; 10:549-60.
    15. Krauss ES, Cronin M, Dengler N, Simonson BG, Altner K, Daly M, et al. The effect of BMI and gender on bleeding events when rivaroxaban is administered for thromboprophylaxis following total hip and total knee arthroplasty. Semin Thromb Hemost. 2019; 45:180-6.
    16. Sharif-Barfeh Z, Beigoli S, Marouzi S, Rad AS, Asoodeh A, Chamani J. Multi-spectroscopic and HPLC studies of the interaction between estradiol and cyclophosphamide with human serum albumin: binary and ternary systems. Journal of Solution Chemistry. 2017 Feb 1;46(2):488-504.
    17. Moore KT, Kröll D. Influences of obesity and bariatric surgery on the clinical and pharmacologic profile of rivaroxaban. Am J Med. 2017; 130:1024-32. 
    18. Tittl L, Endig S, Marten S, Reitter A, Beyer-Westendorf I, Beyer-Westendorf J. Impact of BMI on clinical outcomes of NOAC therapy in daily care-Results of the prospective Dresden NOAC Registry (NCT01588119). Int J Cardiol. 2018; 262:85-91. 
    19. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med. 1998; 158:1855-67.
    20. Sanei H, Asoodeh A, Hamedakbari-Tusi S, Chamani J. Multi-spectroscopic investigations of aspirin and colchicine interactions with human hemoglobin: binary and ternary systems. Journal of Solution Chemistry. 2011 Nov 1;40(11):1905-31.
    21. Freyburger G, Macouillard G, Labrouche S, Sztark F. Coagulation parameters in patients receiving dabigatran etexilate or rivaroxaban: two observational studies in patients undergoing total hip or total knee replacement. Thromb Res. 2011; 127:457-65.
    22. Di Nisio M, Vedovati MC, Riera-Mestre A, Prins MH, Mueller K, Cohen AT, et al. Treatment of venous thromboembolism with rivaroxaban in relation to body weight. Thromb Haemost. 2016; 116:739-46.
    23. Kubitza D, Becka M, Roth A, Mueck W. The influence of age and gender on the pharmacokinetics and pharmacodynamics of rivaroxaban--an oral, direct factor Xa inhibitor. J Clin Pharmacol. 2013; 53:249-55.
    24. Chamani J, Heshmati M. Mechanism for stabilization of the molten globule state of papain by sodium n-alkyl sulfates: spectroscopic and calorimetric approaches. J Colloid Interface Sci. 2008;322(1):119-27.
    25. Kubitza D, Becka M, Zuehlsdorf M, Mueck W. Body weight has limited influence on the safety, tolerability, pharmacokinetics, or pharmacodynamics of rivaroxaban (BAY 59-7939) in healthy subjects. J Clin Pharmacol. 2007; 47:218-26. 
    26. De Caterina R, Lip GYH. The non-vitamin K antagonist oral anticoagulants (NOACs) and extremes of body weight-a systematic literature review. Clin Res Cardiol. 2017; 106:565-72.
    27. Goodman SG, Wojdyla DM, Piccini JP, White HD, Paolini JF, Nessel CC, et al. Factors associated with major bleeding events: insights from the ROCKET AF trial (rivaroxaban once-daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation). J Am Coll Cardiol. 2014; 63:891-900.
    28. Moosavi-Movahedi AA, Chamani J, Gharanfoli M, Hakimelahi GH. Differential scanning calorimetric study of the molten globule state of cytochrome c induced by sodium n-dodecyl sulfate. Thermochim Acta. 2004; 409:137-44.
    29. Barsam SJ, Patel JP, Roberts LN, Kavarthapu V, Patel RK, Green B, et al. The impact of body weight on rivaroxaban pharmacokinetics. Res Pract Thromb Haemost. 2017; 1:180-7.
    30. Weinstein JR, Anderson S. The aging kidney: physiological changes. Adv Chronic Kidney Dis. 2010; 17:302-7.
    31. Gerchman F, Tong J, Utzschneider KM, Zraika S, Udayasankar J, McNeely MJ, et al. Body mass index is associated with increased creatinine clearance by a mechanism independent of body fat distribution. J Clin Endocrinol Metab. 2009; 94:3781-8. 

     

     

     

     

Journal of Cardio-Thoracic Medicine
Volume 7, Issue 3
September 2019
Pages 491-498

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