Objective To study the effect of activated charcoal treatment of rivaroxaban on the results of coagulation tests. Methods The sodium citrate anticoagulant blood samples were collected from the physical examination population after the detection of clinical routine coagulation items. Twenty cases were conveniently taken each time, repeated 24 times, and a total of 480 cases were included. Twenty plasma samples were mixed and configured as normal mixed plasma (NPP), and 1 mL NPP was set as the N1 group. NPP treated with activated carbon was used as the N2 group. NPP added with different mass concentrations of rivaroxaban was used as the N3 group, including 100 μg/L (the N3A group), 200 μg/L (the N3B group), 300 μg/L (the N3C group) and 400 μg/L (the N3D group). Each mass concentration was repeated 6 times. The N3 group was used as the N4 group after treatment with activated carbon. A total of 22 patients in the emergency department who were treated with rivaroxaban for the first time were collected. Blood samples collected 6 h before and 6 h after rivaroxaban were divided into the S1 group and the S2 group, respectively. After treatment with activated carbon, S2 group was used as the S3 group. The mass concentrations of rivaroxaban in the N3 group and the S2 group were determined by liquid chromatography-tandem mass spectrometry. The levels of prothrombin time (PT), activated partial thrombin time (APTT), thrombin time (TT) and fibrinogen (FIB) in the N1 group, the N2 group, the N3 group and the N4 group were detected. The activities of protein C (PC), protein S (PS), antithrombin Ⅲ (AT-Ⅲ) and coagulation factors FⅡ, FⅤ, FⅦ, FⅧ, FⅨ, FⅩ, FⅪ and FⅫ and the activities of anti-Xa factor (Anti-Xa) in the N1 group, the N2 group, the N3 group, the N4 group, the S1 group, the S2 group and the S3 group were also detected in each group. Results Compared with the N1 group, there were no significant differences in PT, APTT, INR, FIB, PC, PS, AT-Ⅲ, Anti-Xa, FⅡ, FⅤ, FⅦ, FⅧ, FⅨ, FⅩ, FⅪ and FⅫ activity in the N2 group. In the N3 group, PT and APTT were prolonged, INR levels were increased, PS, AT-Ⅲ and Anti-Xa activities were increased, and FⅡ, FⅤ, FⅦ, FⅧ, FⅨ, FⅩ, FⅪ and FⅫ activities were decreased (P<0.01). There were no significant differences in PC activity and FIB level. APTT was prolonged in the N4 group, while PS, FⅤ, FⅧ, FⅪ and FⅫ activities decreased (P<0.01). Compared with the N3 group, PT and APTT decreased, INR level, PS, AT-Ⅲ and Anti-Xa activity decreased significantly, FⅡ, FⅤ, FⅦ, FⅧ, FⅨ, FⅩ, FⅪ and FⅫ activities increased in the N4 group (P<0.01). There were no significant differences in FIB level and PC activity between the N3 group and the N4 group. Compared with the S1 group, Anti-Xa activity was increased and APTT was prolonged in the S2 group. APTT was prolonged in the S3 group (P<0.01). Compared with the S2 group, Anti-Xa activity was decreased and APTT was shortened in the S3 group. The levels of PT, INR, APTT and PS, and the activity of Anti-Xa were successively increased in the N3A group, the N3B group, the N3C group and the N3D group, while the activities of FⅤ, FⅦ, FⅧ, FⅨ and FⅪ were successively decreased (P<0.01). There was a positive correlation between rivaroxaban mass concentration and Anti-Xa activity in the N3 group and the S2 group (rs = 0.989, 0.969, P<0.01). Conclusion Activated carbon can effectively remove rivaroxaban from plasma and reverse the abnormal coagulation index caused by rivaroxaban.
