Effects of dabigatran, rivaroxaban, and apixaban on fibrin network permeability, thrombin generation, and fibrinolysis.

IF 1.3 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Scandinavian Journal of Clinical & Laboratory Investigation Pub Date : 2024-07-01 Epub Date: 2024-07-02 DOI:10.1080/00365513.2024.2369993
Viktor Schutz Taune, Michal Zabczyk, Shu He, Anna Ågren, Margareta Blombäck, Håkan Wallén, Mika Skeppholm
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Abstract

Introduction: There are important pharmacological differences between direct oral anticoagulants (DOAC) and a deeper knowledge of how they influence different aspects of hemostasis in patients on treatment is desirable.

Materials and methods: Blood samples from patients on dabigatran (n = 23), rivaroxaban (n = 26), or apixaban (n = 20) were analyzed with a fibrin network permeability assay, a turbidimetric clotting and lysis assay, the calibrated automated thrombogram (CAT), plasma levels of thrombin-antithrombin complex (TAT) and D-dimer, as well as DOAC concentrations, PT-INR and aPTT. As a comparison, we also analyzed samples from 27 patients on treatment with warfarin.

Results: Patients on dabigatran had a more permeable fibrin network, longer lag time (CAT and turbidimetric assay), and lower levels of D-dimer in plasma, compared with patients on rivaroxaban- and apixaban treatment, and a more permeable fibrin network than patients on warfarin. Clot lysis time was slightly longer in patients on dabigatran than in patients on rivaroxaban. Warfarin patients formed a more permeable fibrin network than patients on apixaban, had longer lag time than patients on rivaroxaban (CAT assay), and lower peak thrombin and ETP compared to patients on treatment with both FXa-inhibitors.

Conclusions: Results from this study indicate dabigatran treatment is a more potent anticoagulant than apixaban and rivaroxaban. However, as these results are not supported by clinical data, they are probably more related to the assays used and highlight the difficulty of measuring and comparing the effect of anticoagulants.

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达比加群、利伐沙班和阿哌沙班对纤维蛋白网络通透性、凝血酶生成和纤维蛋白溶解的影响。
简介:直接口服抗凝血剂(DOAC)之间存在着重要的药理差异,因此需要更深入地了解这些药物如何影响患者治疗过程中止血的不同方面:直接口服抗凝药(DOAC)之间存在着重要的药理差异,因此需要更深入地了解这些药物如何影响正在接受治疗的患者止血的不同方面:对服用达比加群(23 例)、利伐沙班(26 例)或阿哌沙班(20 例)患者的血样进行了纤维蛋白网络渗透性测定、浊度凝血和裂解测定、校准自动血栓图(CAT)、血浆凝血酶-抗凝血酶复合物(TAT)和 D-二聚体水平以及 DOAC 浓度、PT-INR 和 aPTT 分析。作为对比,我们还分析了27名接受华法林治疗的患者的样本:与接受利伐沙班和阿哌沙班治疗的患者相比,服用达比加群的患者血浆中纤维蛋白网络的渗透性更强,滞后时间(CAT和浊度测定法)更长,D-二聚体水平更低,而服用华法林的患者血浆中纤维蛋白网络的渗透性更强。服用达比加群的患者血栓溶解时间略长于服用利伐沙班的患者。与服用两种FXa抑制剂的患者相比,服用华法林的患者形成的纤维蛋白网络比服用阿哌沙班的患者更具渗透性,滞后时间比服用利伐沙班(CAT检测)的患者更长,凝血酶峰值和ETP更低:本研究结果表明,达比加群比阿哌沙班和利伐沙班的抗凝效果更好。然而,由于这些结果没有得到临床数据的支持,它们可能更多地与所使用的检测方法有关,并凸显了测量和比较抗凝剂效果的难度。
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来源期刊
CiteScore
3.50
自引率
4.80%
发文量
85
审稿时长
4-8 weeks
期刊介绍: The Scandinavian Journal of Clinical and Laboratory Investigation is an international scientific journal covering clinically oriented biochemical and physiological research. Since the launch of the journal in 1949, it has been a forum for international laboratory medicine, closely related to, and edited by, The Scandinavian Society for Clinical Chemistry. The journal contains peer-reviewed articles, editorials, invited reviews, and short technical notes, as well as several supplements each year. Supplements consist of monographs, and symposium and congress reports covering subjects within clinical chemistry and clinical physiology.
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