Differences in coagulation responses to vascular injury between uninterrupted dabigatran and apixaban: A clinical prospective randomized study

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2025-01-01 DOI:10.1016/j.hrthm.2024.07.017

Yasuhiro Ikami MD , Daisuke Izumi MD , Shinya Fujiki MD , Hirotaka Sugiura MD , Sou Otsuki MD , Naomasa Suzuki MD , Yuta Sakaguchi MD , Takahiro Hakamata MD , Yuki Hasegawa MD , Nobue Yagihara MD , Kenichi Iijima MD , Takahiro Tanaka PhD , Masahiro Ishizawa MD , Masaomi Chinushi MD , Tohru Minamino MD , Takayuki Inomata MD

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引用次数: 0

Abstract

Background

The coagulation response during vascular injury with uninterrupted administration of direct oral anticoagulants has not been elucidated.

Objective

Our aim was to evaluate differences in coagulation responses after vascular injury between uninterrupted direct thrombin inhibitor and direct factor Xa inhibitor recipients.

Methods

Patients scheduled for catheter ablation for atrial fibrillation were randomly assigned to receive dabigatran or apixaban in this prospective, randomized, comparative, parallel-group study. Venous blood was collected 3 times: 180 minutes after taking the anticoagulant on the day before the procedure, before vascular punctures of the ablation procedure, and 10–15 minutes after the start of vascular punctures.

Results

Forty-two patients were enrolled. The prothrombin fragment 1+2 level, the primary end point, was much larger after vascular puncture in the uninterrupted dabigatran recipients (median, 83 pmol/L; interquartile range, 56–133 pmol/L) than in the uninterrupted apixaban recipients (median, 1 pmol/L; interquartile range, −3 to 19 pmol/L; P < .001). Antithrombin levels decreased after vascular puncture in dabigatran recipients, and both protein C and antithrombin levels decreased after vascular puncture in apixaban recipients.

Conclusion

Unlike uninterrupted apixaban, uninterrupted dabigatran does not inhibit thrombin generation in response to vascular injury.

Abstract Image

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不间断达比加群和阿哌沙班对血管损伤的凝血反应差异--一项临床前瞻性随机研究。

背景：直接口服抗凝血剂（DOACs）在血管损伤后的凝血反应尚未阐明：我们的目的是评估不间断使用直接凝血酶抑制剂和直接 Xa 因子抑制剂的患者在血管损伤后凝血反应的差异：在这项前瞻性、随机、比较、平行组研究中，计划接受心房颤动导管消融术的患者被随机分配接受达比加群或阿哌沙班治疗。研究人员采集了三次静脉血：分别在手术前一天服用抗凝剂后 180 分钟、消融手术血管穿刺前和血管穿刺开始后 10-15 分钟采集静脉血：结果：42 名患者入选。主要终点凝血酶原碎片1+2（F1+2）水平在血管穿刺后，未中断达比加群者（中位数：83 pmol/L；四分位间距：56-133 pmol/L）远高于未中断阿哌沙班者（中位数：1 pmol/L；四分位间距：-3-19 pmol/L；P < 0.001）。达比加群受试者血管穿刺后抗凝血酶水平下降，而阿哌沙班受试者血管穿刺后蛋白C和抗凝血酶水平均下降：结论：与不间断使用阿哌沙班不同，不间断使用达比加群不会抑制血管损伤时凝血酶的生成。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.