Preferred Sample Type

Anti-Xa Assay

Anti-Xa Assay

Specimen Volume

3.5 mL (Vacuette tubes) or 2.7mL (BD Vacutainer tubes)

Specimen Transport

Standard transport to laboratory - State for the attention of Special Coagulation on request form

Sample Preparation

Samples must be filled to the black fill line (Vacuette tubes) or the frosted line (BD Vacutainer tubes) indicated on the sample tube. Any sample filled above or below this level will be rejected and a repeat sample will be required

Turnaround Time

7 days (Unless urgent by prior arrangement with laboratory)

Sample Processing In Laboratory

Sample should be centrifuged

Sample Stability

12 hours from venepuncture (ideally received no later than 4 hours after collection)

General Information

Test Availability:

Queen Elizabeth and Heartlands sites: LMWH

Queen Elizabeth site only: UFH, Apixaban, Rivaroxaban, Fondaparinux

Heartlands site only: Edoxaban

Samples received at each site will be sent on to the appropriate laboratory for testing.

For urgent special coagulation assay information click Here

External Requests:

Note: For external requests please click Here for Coagulation Disorders request form. Please complete all information fully.

Sample packing and transportation:

Frozen plasma should be sent on dry ice using an insulated container to ensure that it remains frozen during transport. Please refer to the preanalytical variables section of the BSH guidelines on the laboratory aspects of assays used in haemostasis and thrombosis1.

As an alternative the bio-freeze container system can be used to ensure samples remain frozen in transit. These have been locally validated to maintain samples at -20oC for up to 12 hours  providing they have been preconditioned in a -80oC freezer for 24 hours prior to use.

Disclaimer:

Please note failure to use an appropriate transit container may affect sample integrity, thus the accuracy of results cannot be guaranteed.  Furthermore, samples packaged incorrectly that arrive in a thawed state cannot be tested.

Please contact the laboratory on 0121 371 5988 (Queen Elizabeth Hospital) or 0121 424 0908 (Heartlands Hospital) if you require any further information.

1) Baker, P., Platton, S., Gibson, C., Gray, E., Jennings, I., Murphy, P., Laffan, M. and British Society for Haematology, Haemostasis and Thrombosis Task Force (2020), Guidelines on the laboratory aspects of assays used in haemostasis and thrombosis. Br. J. Haematol., 191: 347-362.

https://doi.org/10.1111/bjh.16776

Samples that meet the following criteria will not be processed:

  • Haemolysed, clotted, underfilled or overfilled samples.
  • Samples >12 hours old from the time of collection.
  • Samples received from other hospital laboratories that have been frozen and thawed.
  • Samples which fail the minimum data set.

Assay Limitations:

  • For accurate results samples should be collected 3-4 hours post dose, when the concentration in the blood is expected to be at peak level.
  • Random and trough anti-Xa tests may also be requested when there are concerns that the anticoagulant may be accumulating e.g. in renal failure.
  • If heparin is being given by continuous venous infusion, samples can be taken at any time but they must be taken from the other arm.

Notes

Please state anticoagulant on request form e.g. LMWH, UFH, Apixaban, Rivaroxaban, Fondaparinux or Edoxaban. Samples must be collected 4 hours post dose.

LMWH: Samples should be taken 4 hours after subcutaneous injection, once steady state has been achieved after administration of at least three doses.

Reference Range

LMWH:

Prophylactic Reference Range 0.1-0.3 IU/mL

Therapeutic Range 0.5-1.0 IU/mL

Therapeutic range for mechanical heart valve during pregnancy 1.0-1.4 IU/mL

Rivaroxaban:

Stroke prevention in NVAF 20mg OD 184-343ng/mL[1]

Treatment of PE/DVT 20mg OD 189-419ng/mL[1]

Treatment of PE/DVT 10mg OD 7-273ng/mL[2]

Treatment of ACS 2.5mg OD 13-123ng/mL[2]

Apixaban:

Stroke prevention in NVAF 5mg BD 91-321ng/mL[1]

Stroke prevention in NVAF 2.5mg BD 69-221ng/mL[2]

Treatment of PE/DVT 10mg BD 111-572ng/mL[2]

Treatment of PE/DVT 5mg BD 59-302ng/mL[1]

Treatment of PE/DVT 2.5mg BD 30-153ng/mL[2]

Fondaparinux:

2.5mg OD 0.39-0.50ug/mL[1]

7.5mg OD 1.20-1.26ug/ml[1]

Edoxaban:

Stroke prevention in NVAF 60mg OD 125-245ng/mL[1]

Treatment of PE/DVT 60mg OD 149-317ng/mL[1]

Stroke prevention in NVAF 30mg OD 55-120ng/mL[2]

Treatment of PE/DVT 30mg OD 99-125ng/mL[2]

 

[1] Measurement of heparin, direct oral anti-coagulants and other non-coumarin anti-coagulants and their effects on haemostasis assays: A British Society for Haematology Guideline, Baker et al, Brit J Haematol, 2024

[2] Update of the International Council for Standardization in Haematology Recommendations for Laboratory Measurement of Direct Oral Anticoagulant, Douxfils et al, Thromb Haemost, 2021

Specifications

  • EQA Status: NEQAS / ECAT
  • EQAS Scheme: Yes

General Information

General information about the website and its content

Location of Laboratories

Where the laboratories are located and information about the services offered at each laboratory