Efficacy and Safety of Rivaroxaban, Apixaban, and Edoxaban for Nonvalvular Atrial Fibrillation Based on Blood Coagulation Activity and Drug Plasma Concentration: SETtsu and North Osaka Multicenter Direct Oral AntiCoagulant (SET DOAC) Registry
<b>Background:</b> The therapeutic effects of oral anticoagulant drugs for nonvalvular atrial fibrillation (NVAF) suggest that the three factor Xa (FXa) inhibitors may have distinct safety profiles, though this is not yet fully conclusive. This study investigated the current dosing of ri...
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2024-10-01
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| author | Michihiro Suwa Isao Morii Masaya Kino Yumie Matsui Masahiro Yoshinaga Hiroki Takahashi Masahiko Takagi Akira Yoshida Minoru Ichikawa Osamu Nakajima Mitsuhiro Tanimura Hisashi Shimoyama Hiroyuki Saitoh Isao Sasaki Takeshi Suzuki Satoshi Uemae |
| author_facet | Michihiro Suwa Isao Morii Masaya Kino Yumie Matsui Masahiro Yoshinaga Hiroki Takahashi Masahiko Takagi Akira Yoshida Minoru Ichikawa Osamu Nakajima Mitsuhiro Tanimura Hisashi Shimoyama Hiroyuki Saitoh Isao Sasaki Takeshi Suzuki Satoshi Uemae |
| author_sort | Michihiro Suwa |
| collection | DOAJ |
| description | <b>Background:</b> The therapeutic effects of oral anticoagulant drugs for nonvalvular atrial fibrillation (NVAF) suggest that the three factor Xa (FXa) inhibitors may have distinct safety profiles, though this is not yet fully conclusive. This study investigated the current dosing of rivaroxaban, apixaban, and edoxaban by monitoring drug plasma concentration (PC) and coagulation activity from the viewpoint of the safety. <b>Methods and results:</b> This multicenter clinical study monitored the drug PC and two coagulation biomarkers (fibrinogen and fibrin monomer complex [FMC]) at peak and trough timing in 268 outpatients taking rivaroxaban (n = 72), apixaban (n = 71), and edoxaban (n = 125) for NVAF. Doses were adjusted based on the dose-adjustment criteria of each drug. Referencing our previous study, peak drug PC remained below the cut-off level for predicting bleeding events except in eight patients (rivaroxaban, n = 3; apixaban, n = 2; edoxaban, n = 3) in whom bleeding events occurred. Among them, two (one each on rivaroxaban and edoxaban) had a peak drug PC below the cut-off level. Drug PCs widely varied from peak to trough, whereas FMC levels, reflecting thrombin activity, remained within the normal range (<6.1 µg/mL) regardless of PC variations. These results indicated that the anticoagulant effects of these drugs persisted throughout the day regardless of the drug PC levels, dosage, and dosing frequency. Regarding the change over time in peak PC, the elevation over time developed more in rivaroxaban (29/57; 50.9%, <i>p</i> < 0.05) than in edoxaban (32/101; 31.7%), and rivaroxaban tended to accumulate more than edoxaban. <b>Conclusions:</b> Although drug PC levels of once-daily FXa inhibitors widely varied from peak to trough, FMC levels were maintained within the normal range without daily variations. Rivaroxaban also tended to accumulate over time. The results indicate the low risk of thrombotic events with once-daily FXa inhibitors and its correspondence to the twice-daily regimen. |
| format | Article |
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| language | English |
| publishDate | 2024-10-01 |
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| spelling | doaj-art-a58064e4ed8742f4868d9983ecfc612b2025-08-20T01:54:08ZengMDPI AGPharmaceuticals1424-82472024-10-011711143110.3390/ph17111431Efficacy and Safety of Rivaroxaban, Apixaban, and Edoxaban for Nonvalvular Atrial Fibrillation Based on Blood Coagulation Activity and Drug Plasma Concentration: SETtsu and North Osaka Multicenter Direct Oral AntiCoagulant (SET DOAC) RegistryMichihiro Suwa0Isao Morii1Masaya Kino2Yumie Matsui3Masahiro Yoshinaga4Hiroki Takahashi5Masahiko Takagi6Akira Yoshida7Minoru Ichikawa8Osamu Nakajima9Mitsuhiro Tanimura10Hisashi Shimoyama11Hiroyuki Saitoh12Isao Sasaki13Takeshi Suzuki14Satoshi Uemae15Department of Cardiology, Hokusetsu General Hospital, Osaka 569-8585, JapanDepartment of Cardiology, Hokusetsu General Hospital, Osaka 569-8585, JapanDepartment of Cardiology, Hokusetsu General Hospital, Osaka 569-8585, JapanDepartment of Cardiology, Saiseikai Izuo Hospital, Osaka 551-0032, JapanDepartment of Cardiology, Saiseikai Izuo Hospital, Osaka 551-0032, JapanDepartment of Cardiology, Kansai Medical University Medical Center, Moriguchi 570-8507, JapanDepartment of Cardiology, Kansai Medical University Medical Center, Moriguchi 570-8507, JapanDepartment of Cardiology, Higashiosaka Municipal Hospital, Higashiosaka, 578-8588, JapanDepartment of Cardiology, Higashiosaka Municipal Hospital, Higashiosaka, 578-8588, JapanDepartment of Cardiology, Hirakata Municipal Hospital, Hirakata 573-1013, JapanMidorigaoka Hospital, Takatsuki 569-1121, JapanItami City Hospital, Itami 664-8540, JapanDepartment of Cardiology, Yukoukai General Hospital, Ibaraki 567-0058, JapanAinomiyako Neurosurgery Hospital, Osaka 538-0044, JapanSysmex Corporation, Kobe 651-2241, JapanSysmex Corporation, Kobe 651-2241, Japan<b>Background:</b> The therapeutic effects of oral anticoagulant drugs for nonvalvular atrial fibrillation (NVAF) suggest that the three factor Xa (FXa) inhibitors may have distinct safety profiles, though this is not yet fully conclusive. This study investigated the current dosing of rivaroxaban, apixaban, and edoxaban by monitoring drug plasma concentration (PC) and coagulation activity from the viewpoint of the safety. <b>Methods and results:</b> This multicenter clinical study monitored the drug PC and two coagulation biomarkers (fibrinogen and fibrin monomer complex [FMC]) at peak and trough timing in 268 outpatients taking rivaroxaban (n = 72), apixaban (n = 71), and edoxaban (n = 125) for NVAF. Doses were adjusted based on the dose-adjustment criteria of each drug. Referencing our previous study, peak drug PC remained below the cut-off level for predicting bleeding events except in eight patients (rivaroxaban, n = 3; apixaban, n = 2; edoxaban, n = 3) in whom bleeding events occurred. Among them, two (one each on rivaroxaban and edoxaban) had a peak drug PC below the cut-off level. Drug PCs widely varied from peak to trough, whereas FMC levels, reflecting thrombin activity, remained within the normal range (<6.1 µg/mL) regardless of PC variations. These results indicated that the anticoagulant effects of these drugs persisted throughout the day regardless of the drug PC levels, dosage, and dosing frequency. Regarding the change over time in peak PC, the elevation over time developed more in rivaroxaban (29/57; 50.9%, <i>p</i> < 0.05) than in edoxaban (32/101; 31.7%), and rivaroxaban tended to accumulate more than edoxaban. <b>Conclusions:</b> Although drug PC levels of once-daily FXa inhibitors widely varied from peak to trough, FMC levels were maintained within the normal range without daily variations. Rivaroxaban also tended to accumulate over time. The results indicate the low risk of thrombotic events with once-daily FXa inhibitors and its correspondence to the twice-daily regimen.https://www.mdpi.com/1424-8247/17/11/1431anticoagulation monitoringapixabanatrial fibrillationedoxabanon-label dosingrivaroxaban |
| spellingShingle | Michihiro Suwa Isao Morii Masaya Kino Yumie Matsui Masahiro Yoshinaga Hiroki Takahashi Masahiko Takagi Akira Yoshida Minoru Ichikawa Osamu Nakajima Mitsuhiro Tanimura Hisashi Shimoyama Hiroyuki Saitoh Isao Sasaki Takeshi Suzuki Satoshi Uemae Efficacy and Safety of Rivaroxaban, Apixaban, and Edoxaban for Nonvalvular Atrial Fibrillation Based on Blood Coagulation Activity and Drug Plasma Concentration: SETtsu and North Osaka Multicenter Direct Oral AntiCoagulant (SET DOAC) Registry Pharmaceuticals anticoagulation monitoring apixaban atrial fibrillation edoxaban on-label dosing rivaroxaban |
| title | Efficacy and Safety of Rivaroxaban, Apixaban, and Edoxaban for Nonvalvular Atrial Fibrillation Based on Blood Coagulation Activity and Drug Plasma Concentration: SETtsu and North Osaka Multicenter Direct Oral AntiCoagulant (SET DOAC) Registry |
| title_full | Efficacy and Safety of Rivaroxaban, Apixaban, and Edoxaban for Nonvalvular Atrial Fibrillation Based on Blood Coagulation Activity and Drug Plasma Concentration: SETtsu and North Osaka Multicenter Direct Oral AntiCoagulant (SET DOAC) Registry |
| title_fullStr | Efficacy and Safety of Rivaroxaban, Apixaban, and Edoxaban for Nonvalvular Atrial Fibrillation Based on Blood Coagulation Activity and Drug Plasma Concentration: SETtsu and North Osaka Multicenter Direct Oral AntiCoagulant (SET DOAC) Registry |
| title_full_unstemmed | Efficacy and Safety of Rivaroxaban, Apixaban, and Edoxaban for Nonvalvular Atrial Fibrillation Based on Blood Coagulation Activity and Drug Plasma Concentration: SETtsu and North Osaka Multicenter Direct Oral AntiCoagulant (SET DOAC) Registry |
| title_short | Efficacy and Safety of Rivaroxaban, Apixaban, and Edoxaban for Nonvalvular Atrial Fibrillation Based on Blood Coagulation Activity and Drug Plasma Concentration: SETtsu and North Osaka Multicenter Direct Oral AntiCoagulant (SET DOAC) Registry |
| title_sort | efficacy and safety of rivaroxaban apixaban and edoxaban for nonvalvular atrial fibrillation based on blood coagulation activity and drug plasma concentration settsu and north osaka multicenter direct oral anticoagulant set doac registry |
| topic | anticoagulation monitoring apixaban atrial fibrillation edoxaban on-label dosing rivaroxaban |
| url | https://www.mdpi.com/1424-8247/17/11/1431 |
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