Collect

One 2.7 mL Sodium Citrate (blue top) tube

Inpatient Collection

Use only for standard (IV) heparin therapy.

Testing is not currently available to monitor levels of oral Anti-Xa inhibitor therapy, i.e. apixaban

Unacceptable Conditions

Aliquot type not properly identified; not Frozen; clotted specimen

Storage/Transport Temperature

Separate from cells ASAP. 1 mL plasma Frozen

Stability (from collection to initiation)

Ambient: 4 hrs (2 hrs if spun/uncapped)

Frozen: One week

Performed

Sun-Sat

Remarks

Sample should be collected 3 hours following dose to evaluate for peak concentration.

Hemostasis/Thrombosis Specimen Collection Guidelines

Department

Coagulation

Notes

Nursing note: Select this assay only if patient is receiving the anticoagulant rivaroxaban (Xarelto®).  Do not select if the patient is receiving heparin, low molecular weight heparin, fondaparinux or apixaban.

Ordering Recommendations

Nursing note: Select this assay only if patient is receiving the anticoagulant rivaroxaban (Xarelto®).  Do not select if the patient is receiving heparin, low molecular weight heparin, fondaparinux or apixaban.

Performed

Sun-Sat

Methodology

Chromogenic

Interpretive Data

No therapeutic reference range for Rivaroxaban has been established.  Observed peak and trough concentrations from published literature are outlined below.  It is recommended the assay be performed 3 hours after administration for peak values.

Dose 20 mg daily 15 mg daily 10 mg daily
Peak Values (ng/ml) 182-408 180-408 91-196
Trough Values (ng/ml) 3-153 2-161 1-38

Laboratory monitoring of Xarelto (rivaroxaban) with Anti-factor Xa activity is not necessary in most patients, but may be useful to assure absence of  drug prior to invasive procedures or use of thrombolytic therapy.

Results may be affected by renal impairment, hepatic impairment, food intake and in the elderly.  The presence of other anti-Xa anticoagulants, such as heparin and fondaparinux may interfere with results.

CPT Codes

85520

Collection

Collect

One 2.7 mL Sodium Citrate (blue top) tube

Inpatient Collection

Use only for standard (IV) heparin therapy.

Testing is not currently available to monitor levels of oral Anti-Xa inhibitor therapy, i.e. apixaban

Unacceptable Conditions

Aliquot type not properly identified; not Frozen; clotted specimen

Storage/Transport Temperature

Separate from cells ASAP. 1 mL plasma Frozen

Stability (from collection to initiation)

Ambient: 4 hrs (2 hrs if spun/uncapped)

Frozen: One week

Performed

Sun-Sat

Remarks

Sample should be collected 3 hours following dose to evaluate for peak concentration.

Hemostasis/Thrombosis Specimen Collection Guidelines

Department

Coagulation

Notes

Nursing note: Select this assay only if patient is receiving the anticoagulant rivaroxaban (Xarelto®).  Do not select if the patient is receiving heparin, low molecular weight heparin, fondaparinux or apixaban.

Ordering

Ordering Recommendations

Nursing note: Select this assay only if patient is receiving the anticoagulant rivaroxaban (Xarelto®).  Do not select if the patient is receiving heparin, low molecular weight heparin, fondaparinux or apixaban.

Performed

Sun-Sat

Methodology

Chromogenic

Result Interpretation

Interpretive Data

No therapeutic reference range for Rivaroxaban has been established.  Observed peak and trough concentrations from published literature are outlined below.  It is recommended the assay be performed 3 hours after administration for peak values.

Dose 20 mg daily 15 mg daily 10 mg daily
Peak Values (ng/ml) 182-408 180-408 91-196
Trough Values (ng/ml) 3-153 2-161 1-38

Laboratory monitoring of Xarelto (rivaroxaban) with Anti-factor Xa activity is not necessary in most patients, but may be useful to assure absence of  drug prior to invasive procedures or use of thrombolytic therapy.

Results may be affected by renal impairment, hepatic impairment, food intake and in the elderly.  The presence of other anti-Xa anticoagulants, such as heparin and fondaparinux may interfere with results.

Administrative

CPT Codes

85520