How the direct oral anticoagulant apixaban affects thrombin generation parameters

Armando Tripodi, Lidia Padovan, Chantarangkul Veena, Erica Scalambrino, Sophie Testa, Flora Peyvandi

Research output: Contribution to journalArticlepeer-review


Background and objectives Apixaban is a direct oral anticoagulant (DOAC) targeting factor Xa and thus quenching thrombin generation and clot formation. However, little information is available on the influence that apixaban may have on the parameters of thrombin generation. Methods Aliquots of a pooled normal plasma have been added with increased concentrations of purified apixaban and were used to assess the degree of modification brought about by the drug on the basic tests of coagulation prothrombin and activated partial thromboplastin time (PT and APTT) and on thrombin generation parameters. Results The study shows that while apixaban has little effect on PT or APTT it does affect all the parameters of thrombin generation, including the lag-time (which is increased), the endogenous thrombin potential (ETP) and thrombin-peak (both decreased although to a different extent), and the velocity index (decreased). Interestingly, the above effects were more pronounced when the measurements were recorded in the presence of thrombomodulin, thus making the ratio (with/without thrombomodulin) to decrease consistently as a function of the apixaban concentrations. Conclusions These findings support the antithrombotic properties of apixaban and can help to understand the mechanism(s) of action of this drug. Thrombin generation could be used as a convenient laboratory tool to assess the anticoagulant activity of other drugs and to make between-DOAC comparison.

Original languageEnglish
Pages (from-to)1186-1190
Number of pages5
JournalThrombosis Research
Issue number6
Publication statusPublished - Jun 1 2015


  • Anticoagulants
  • Partial thromboplastin time
  • Prothrombin time
  • Thrombomodulin
  • Thrombosis

ASJC Scopus subject areas

  • Hematology


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