Can a hypercoagulable workup be done if a patient is already on Eliquis (apixaban)?

Hypercoagulable Workup While on Eliquis (Apixaban)

A hypercoagulable workup should not be performed while a patient is actively taking Eliquis (apixaban) as it can significantly affect certain laboratory test results, leading to inaccurate diagnosis. 1

Impact of Apixaban on Laboratory Testing

Apixaban affects several key coagulation tests that are part of a standard hypercoagulable workup:

• Significantly affected tests (unreliable results):

  • Anti-factor Xa activity assays
  • Prothrombin time (PT)
  • Activated partial thromboplastin time (aPTT)
  • Thrombin generation tests

• Minimally affected tests (more reliable):

  • Antithrombin III activity
  • Protein C and S antigen levels (not activity)
  • Factor V Leiden genetic testing
  • Prothrombin gene mutation
  • Antiphospholipid antibody testing

Recommended Approach for Hypercoagulable Testing

For Standard Risk Patients:

1. Temporarily discontinue Eliquis:
   • Allow 3-5 days for drug clearance
   • Perform comprehensive hypercoagulable workup
   • Resume Eliquis promptly after testing 1

For High-Risk Patients:

For patients with recent thrombosis or multiple prior events where anticoagulation cannot be safely interrupted:

1. Consider bridging therapy:

   • Switch to argatroban (very short half-life)
   • Alternative: fondaparinux
   • These agents allow for more accurate testing while maintaining anticoagulation 1

2. Consult with prescribing physician before making any changes to anticoagulation regimen

Important Considerations

• Risk assessment: Evaluate the patient's thrombotic risk before discontinuing anticoagulation
• Timing: Schedule testing when the risk of thrombosis is lowest
• Monitoring: If bridging is used, appropriate monitoring of alternative anticoagulants is essential

Potential Pitfalls

• Performing hypercoagulable testing while on Eliquis can lead to false results and misdiagnosis
• Discontinuing anticoagulation without proper bridging in high-risk patients can lead to thrombotic events 2
• Failing to resume anticoagulation promptly after testing increases thrombotic risk

Follow-up Management

• After completing the hypercoagulable workup, promptly resume Eliquis at the previously prescribed dose
• For patients with confirmed hypercoagulable states, Eliquis is an appropriate treatment option 3
• Regular monitoring of renal function is essential for patients on Eliquis, especially in elderly patients 1

By following these guidelines, clinicians can obtain accurate hypercoagulable testing results while maintaining patient safety and minimizing thrombotic risk.