Elevated PTT in patient on eliquis

[PainBrain78]

Patient on eliquis with elevated pro time and PTT. He REALLY wants a lumbar SCS. Am I correct in saying his Eliquis does not explain the elevations?
Would you proceed with lumbar SCS trial?

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[lobelsteve]

Should not.
Good call to Heme/Onc.
Vit K def?

I'd delay SCS until known risk identified., even if PTT only mildly elevated.

 

[Ducttape]

Were those tests done when the patient was on eliquis?

There can be a mild elevation similar to that you are seeing. Unfortunately you can only get a true test by taking people off eliquis....

I'm guessing heme will say that it is no big deal.

 

[PainBrain78]

Yes they were taken while patient was on eliquis in preparation for SCS trial.

Side note I typically don’t order labs prior to trial. His insurance required it.

 

[JeffGarrett]

Yes they were taken while patient was on eliquis in preparation for SCS trial.

Side note I typically don’t order labs prior to trial. His insurance required it.

Just for my own edification can you clarify why you dont typically order labs prior to trial?

 

[au bon pain]

Patient on eliquis with elevated pro time and PTT. He REALLY wants a lumbar SCS. Am I correct in saying his Eliquis does not explain the elevations?
Would you proceed with lumbar SCS trial?

Fwiw, PT and PTT are not reliable measures to track the impact that eliquis may or may not be having on the coagulation cascade.

 

[Orin]

Patient on eliquis with elevated pro time and PTT. He REALLY wants a lumbar SCS. Am I correct in saying his Eliquis does not explain the elevations?
Would you proceed with lumbar SCS trial?

It's a clinically insignificant elevation with likely no clinical signs of increased bleeding/bruising. Give the dude some kale chips and recheck it in the afternoon or morning before he takes his Eliquis.

FWIS, Apixaban can alter some PT/PTT results but that's a problem with the diagnostic assay rather than a measure of apixaban's effect.

Impact of apixaban on routine and specific coagulation assays: a practical laboratory guide - PubMed

Apixaban does not require monitoring nor frequent dose adjustment. However, searching for the optimal dose for the individual patient may be useful in some situations. Moreover, there is a need for clinicians to know whether coagulation assays are influenced by apixaban use. The aim of this...

pubmed.ncbi.nlm.nih.gov

Influence of apixaban on commonly used coagulation assays: results from the Belgian national External Quality Assessment Scheme - PubMed

Our data provide clinical laboratories with useful information on the impact of apixaban on their routine coagulation assays.

pubmed.ncbi.nlm.nih.gov

For a point of reference to discuss the above with:

https://www.sciencedirect.com/science/article/pii/S1347436719300692

https://ars.els-cdn.com/content/image/1-s2.0-S1347436719300692-gr3.jpg

The red lines are 95th/5th percentile while the blue is the 50th percentile of observed concentrations after dosing.
It's not unreasonable then for apixaban to be the culprit if he got blood drawn soon after taking the PO dose, but even if that's the issue, it's not a clinically impressive change in either variable.

 

[PainBrain78]

I never did in fellowship either. I do ask if they have a history bleeding or platelet disorders. My partners don’t either but I’ve considered it. So far I’ve never been burned. Pretty coincidental that this patients’ insurance required it prior to trial.

 

[PainBrain78]

Just for my own edification can you clarify why you dont typically order labs prior to trial?

I never did in fellowship either. I do ask if they have a history bleeding or platelet disorders. My partners don’t either but I’ve considered it. So far I’ve never been burned. Pretty coincidental that this patients’ insurance required it prior to trial.