Table 1.
Summary of published PK/PD data of rivaroxaban and apixaban
| Drug and dosing | Cmax | Cmin* | t1/2 hours | Reference | “Safe residual level” to engage in contact sports† | |
|---|---|---|---|---|---|---|
| ng/mL (range) | ||||||
| Rivaroxaban | 20 mg once daily | 173 (111-294) | 22.3 (4.3-95.7) | 5.2-14.3 | 14 | Unknown; proposal in this manuscript: <30 ng/mL |
| 10 mg once daily | 141 (112-184) | 9.1 (1.3-37.6) | 4.4-32 | 14 | ||
| Apixaban‡ | 5 mg twice daily | 129 | 50 | 11.7 | 18 | Unknown; proposal in this manuscript: <30 ng/mL |
| 2.5 mg twice daily | 62 | 21 | 8.1 | 18 | ||
Data are derived from healthy young volunteers studies, except Cmin values for rivaroxaban.
Cmin values for rivaroxaban are derived from atrial fibrillation patient populations.
Given the lack of scientific data as to what drug level or activity is relatively safe and does not significantly increase major bleeding risk with or without trauma, the determination as to what may constitute a safe DOAC drug level to participate in contact and collision sports is currently empiric and one of expert opinion. The value listed is the authors’ current postulate.
No ranges of values provided in referenced publications; however, wide interindividual ranges for the various PK/PD parameters exist for both apixaban and rivaroxaban.