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Thromb Haemost 2015; 114(01): 78-86
DOI: 10.1160/TH14-10-0877
Coagulation and Fibrinolysis
Schattauer GmbH

Association rate constants rationalise the pharmacodynamics of apixaban and rivaroxaban

Georges Jourdi
1   INSERM UMR_S1140, Faculté de Pharmacie, Paris, France
2   Université Paris Descartes, Sorbonne Paris Cité, Paris, France
,
Virginie Siguret
1   INSERM UMR_S1140, Faculté de Pharmacie, Paris, France
2   Université Paris Descartes, Sorbonne Paris Cité, Paris, France
3   AP-HP, Hôpital Lariboisière, Paris, France
,
Anne Céline Martin
1   INSERM UMR_S1140, Faculté de Pharmacie, Paris, France
2   Université Paris Descartes, Sorbonne Paris Cité, Paris, France
4   Hôpital Val de Grâce, Paris, France
,
Jean-Louis Golmard
5   Université Pierre et Marie Curie, Paris, France
,
Anne Godier
1   INSERM UMR_S1140, Faculté de Pharmacie, Paris, France
2   Université Paris Descartes, Sorbonne Paris Cité, Paris, France
6   Fondation Rothschild, Paris, France
,
Charles-Marc Samama
1   INSERM UMR_S1140, Faculté de Pharmacie, Paris, France
2   Université Paris Descartes, Sorbonne Paris Cité, Paris, France
7   AP-HP, Hôpital Cochin, Paris, France
,
Pascale Gaussem
1   INSERM UMR_S1140, Faculté de Pharmacie, Paris, France
2   Université Paris Descartes, Sorbonne Paris Cité, Paris, France
8   AP-HP, Hôpital Européen Georges Pompidou, Paris, France
,
Isabelle Gouin-Thibault   *
1   INSERM UMR_S1140, Faculté de Pharmacie, Paris, France
2   Université Paris Descartes, Sorbonne Paris Cité, Paris, France
7   AP-HP, Hôpital Cochin, Paris, France
,
Bernard Le Bonniec   *
1   INSERM UMR_S1140, Faculté de Pharmacie, Paris, France
2   Université Paris Descartes, Sorbonne Paris Cité, Paris, France
› Author Affiliations Financial support: This study was supported by the CONNY-MAEVA charitable Foundation.
Further Information

Publication History

Received: 23 October 2014

Accepted after major revision: 17 January 2015

Publication Date:
22 November 2017 (online)

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Summary

Rivaroxaban and apixaban are selective direct inhibitors of free and prothrombinase-bound factor Xa (FXa). Surprisingly prothrombin time (PT) is little sensitive to clinically relevant changes in drug concentration, especially with apixaban. To investigate this pharmacodynamic discrepancy we have compared the kinetics of FXa inhibition in strictly identical conditions (pH 7.48, 37 °C, 0.15 M). KI values of 0.74 ± 0.03 and 0.47 ± 0.02 nM and kon values of 7.3 ± 1.6 106 and 2.9 ± 0.6 107 M-1 s-1 were obtained for apixaban and rivaroxaban, respectively. To investigate if these constants rationalise the inhibitor pharmacodynamics, we used numerical integration to evaluate impact of FXa inhibition on thrombin generation assay (TGA) and PT. Simulation predicted that in TGA triggered with 20 pM tissue factor, 100 ng/ml apixaban or rivaroxaban increased 1.8– or 3.0-fold the lag time and 1.4– or 2.0-fold the time to peak, whilst decreasing 1.2– or 3.1-fold the maximum thrombin and 1.7– or 3.5-fold the endogenous thrombin potential. These numbers were consistent with those obtained through the corresponding TGA triggered in plasma spiked with apixaban or rivaroxaban. Simulated PT ratios were also consistent with the corresponding plasma PT: markedly less sensitive to apixaban than to rivaroxaban. Analogous differences in TGA and PT were obtained irrespective of the drug amount added. We concluded that kon values for FXa of apixaban and rivaroxaban rationalise the unexpected lower sensitivity of PT and TGA to the former.

Keywords

Coagulation factors - protease inhibitors - computer simulation - blood coagulation tests - prothrombin time

* These authors share equal senior authorship.


 

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