POTENTIAL OF THE FACTOR XA INHIBITOR RIVAROXABAN FOR THE ANTICOAGULATION MANAGEMENT OF PATIENTS WITH HEPARIN-INDUCED THROMBOCYTOPENIA
Abstract number: P-M-648
Walenga1 J.M., Jeske1 W.P., Prechel1 M., Hoppensteadt2 D., Swank1 J., Sheen1 L., Misselwitz3 F., Messmore4 H., Bakhos1 M.
11Thoracic and CV Surgery 22Pathology, Loyola University Medical Center, Maywood, United States 33Bayer Healthcare AG, Wuppertal, Germany 44Loyola University Medical Center, Maywood, United States
How-to-cite Walenga JM, Jeske WP, Prechel M, Hoppensteadt D, Swank J, Sheen L, Misselwitz F, Messmore H, Bakhos M. POTENTIAL OF THE FACTOR XA INHIBITOR RIVAROXABAN FOR THE ANTICOAGULATION MANAGEMENT OF PATIENTS WITH HEPARIN-INDUCED THROMBOCYTOPENIA. J Thromb Haemost 2007; 5 Supplement 2: P-M-648
Introduction: Rivaroxaban (BAY 59-7939; Bayer) is an orally bioavailable, small-molecule, direct factor Xa inhibitor (XaI) in advanced clinical trials for the prevention and treatment of thromboembolic disorders. The purpose of this study was to determine the potential of this agent as an anticoagulant for patients with heparin-induced thrombocytopenia (HIT). Rivaroxaban is structurally different from heparin, LMW heparins, and fondaparinux and, therefore, it is not expected to interact with pre-formed HIT antibodies.
Methods: Sera from 89 patients with ELISA positive HIT antibodies that induced platelet activation in the diagnostic 14C-Serotonin Release Assay (SRA) were included in this study. Rivaroxaban was tested in a total of 152 different HIT antibody/donor platelet combinations using three types of platelet function HIT assays (SRA, platelet aggregation, flow cytometry).
Results: Rivaroxaban had no cross-reactivity with any of the HIT antibodies as shown by the lack of platelet activation, platelet aggregation, platelet microparticle generation, and P-selectin up regulation. Further studies demonstrated that rivaroxaban did not promote the release of PF4 from platelets as did heparin and LMW heparin. Rivaroxaban did not bind to PF4.
Conclusions: Taken together these results provide strong evidence that rivaroxaban is not immunogenic for HIT and can be effectively used for anticoagulation of patients with HIT without risk of adverse platelet activation and associated thrombotic side effects from HIT antibody activation. As a XaI, rivaroxaban has advantages over current strategies for the anticoagulant management of HIT patients, such as improved safety/bleeding risk and oral bioavailability that allows for extended patient management.
To cite this abstract use the following format:
Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
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