Apixaban enhances endogenous fibrinolysis in patients with atrial fibrillation.
Aged
Aged, 80 and over
Anticoagulants
/ therapeutic use
Aspirin
/ therapeutic use
Atrial Fibrillation
/ complications
Blood Coagulation Tests
Cross-Sectional Studies
Factor Xa Inhibitors
/ therapeutic use
Female
Fibrin Clot Lysis Time
Fibrinolysis
/ physiology
Humans
Ischemic Stroke
/ etiology
Longitudinal Studies
Male
Middle Aged
Platelet Aggregation Inhibitors
/ therapeutic use
Prospective Studies
Pyrazoles
/ therapeutic use
Pyridones
/ therapeutic use
Thrombelastography
Warfarin
/ therapeutic use
Apixaban
Atrial fibrillation
Endogenous fibrinolysis
Non-vitamin K antagonist oral anticoagulant
Thrombosis
Journal
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
ISSN: 1532-2092
Titre abrégé: Europace
Pays: England
ID NLM: 100883649
Informations de publication
Date de publication:
01 Sep 2019
01 Sep 2019
Historique:
received:
18
04
2019
accepted:
30
05
2019
entrez:
11
9
2019
pubmed:
11
9
2019
medline:
15
12
2020
Statut:
ppublish
Résumé
Approximately 20% of ischaemic stroke patients exhibit spontaneous arterial recanalization, attributable to endogenous fibrinolysis, which strongly relates to improved functional outcome. The impact of oral anticoagulants on endogenous fibrinolysis is unknown. Our aim was to test the hypothesis that apixaban enhances endogenous fibrinolysis in non-valvular atrial fibrillation (NVAF). In a prospective cross-sectional analysis, we compared endogenous fibrinolysis in NVAF patients (n = 180) taking aspirin, warfarin, or apixaban. In a prospective longitudinal study, patients were tested before and after apixaban (n = 80). Endogenous fibrinolysis was assessed using the Global Thrombosis Test (GTT) and thromboelastography (TEG). Endogenous fibrinolysis [measured by GTT lysis time (LT)] was shorter on apixaban compared with warfarin or aspirin [median 1850 (IQR 1591-2300) vs. 2758 (2014-3502) vs. 2135 (1752-2463) s, P < 0.0001]. Among TEG indices, a small but significant difference in clot lysis time (CLT) was observed [apixaban 60.0 (45.0-61.0) vs. warfarin 61.0 (57.0-62.0) vs. aspirin 61.0 (59.0-61.0) min, P = 0.036]. Apixaban improved endogenous fibrinolysis measured using the GTT [LT pre-treatment 2204 (1779-2738) vs. on-treatment 1882 (1607-2374) s, P = 0.0003], but not by using TEG. Change in LT (ΔLT) with apixaban correlated with baseline LT (r = 0.77, P < 0.0001). There was weak correlation between ΔLT and ΔCLT in response to apixaban (r = 0.28, P = 0.02) and between on-apixaban LT and CLT (r = 0.25, P = 0.022). Apixaban enhances endogenous fibrinolysis, with maximal effect in those with impaired fibrinolysis pre-treatment. Apixaban-treated patients exhibit more favourable fibrinolysis profiles than those taking warfarin or aspirin. Whether apixaban may confer additional thrombotic risk reduction in NVAF patients with impaired fibrinolysis, compared to warfarin, merits further study.
Identifiants
pubmed: 31505618
pii: 5522956
doi: 10.1093/europace/euz176
pmc: PMC6735819
doi:
Substances chimiques
Anticoagulants
0
Factor Xa Inhibitors
0
Platelet Aggregation Inhibitors
0
Pyrazoles
0
Pyridones
0
apixaban
3Z9Y7UWC1J
Warfarin
5Q7ZVV76EI
Aspirin
R16CO5Y76E
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1297-1306Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
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