Abstract
Rivaroxaban and Apixaban, increasingly used for stroke prevention in non-valvular atrial fibrillation (AF), might impact platelet reactivity directly or indirectly. By inhibition of Factor Xa (FXa) they preclude not only generation of relevant thrombin amounts but also block signalling of FXa via protease activated receptors. However, weather FXa-inhibition affects platelet haemostasis remains incompletely known. One hundred and twenty-eight patients with AF on chronic anticoagulation with either Rivaroxaban or Apixaban for at least 4 weeks were included in the study. In a time course group (25 on Rivaroxaban, 13 on Apixaban) venous blood samples were taken before NOAC medication intake in the morning as well as 2 and 6 h afterwards. In 90 patients (Rivaroxaban n = 73, Apixaban n = 17) blood samples were drawn during left atrial RFA procedures before as well as 10 and 60 min after the first heparin application (RFA group). Platelet reactivity analyzed by whole blood aggregometry (Multiplate Analyzer, Roche) in response to ADP, Collagen, TRAP and ASPI (arachidonic acid) was not altered by Rivaroxaban or Apixaban neither in the time course nor in the RFA group. Moreover, soluble P-selectin, Thrombospondin, von Willebrand Factor and beta thromboglobulin plasma levels, measured by ELISA, showed no statistically significant changes in both clinical settings for either FXa-inhibitor. The present study fails to demonstrate any significant changes on platelet reactivity in patients with AF under chronic Rivaroxaban or Apixaban medication, neither for trough or peak levels nor in case of a haemostatic activation in vivo as depicted by RFA procedures.
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References
Furie B, Furie BC (2012) Formation of the clot. Thromb Res Suppl 1:S44–S46. doi:10.1016/j.thromres.2012.08.272.
Brass LF (2003) Thrombin and platelet activation. Chest 124(3 Suppl):18S–25S
Posma JJ, Posthuma JJ, Spronk HM (2016) Coagulation and non-coagulation effects of thrombin. Thromb Haemost 14(10):1908–1916. doi:10.1111/jth.13441
Schulman S (2013) Advantages and limitations of the new anticoagulants. J Intern Med 275(1):1–11. doi:10.1111/joim.12138
Hicks T, Stewart F, Eisinga A (2016) NOACs versus warfarin for stroke prevention in patients with AF: a systematic review and meta-analysis. Open Heart 3(1):18
Dillier R, Ammar S, Hessling G, Kaess B, Pavaci H, Buiatti A, Semmler V, Kathan S, Hofmann M, Lennerz C, Kolb C, Reents T, Deisenhofer I (2014) Safety of continuous periprocedural Rivaroxaban for patients undergoing left atrial catheter ablation procedures. Circ Arrhythm Electrophysiol 7:576–582
Kaess BM, Ammar S, Reents T, Dillier R, Lennerz C, Semmler V, Grebmer C, Bourier F, Buiatti A, Kolb C, Deisenhofer I, Hessling G (2015) Comparison of safety of left atrial catheter ablation procedures for atrial arrhythmias under continuous anticoagulation with Apixaban versus phenprocoumon. Am J Cardiol 115:47–51
Sibbing D, Busch G, Braun S, Jawansky S, Schömig A, Kastrati A, Ott I, von Beckerath N (2008) Impact of bivalirudin or unfractionated heparin on platelet aggregation in patients pretreated with 600 mg clopidogrel undergoing elective percutaneous coronary intervention. Eur Heart J 29(12):1504–1509. doi:10.1093/eurheartj/ehn195
Demetz G, Laux M, Scherhag A, Hoekstra T, Suttorp MM, Dekker F, Roest M, Marcus-Kalish M, Mittelman M, Ott I (2014) The influence of Erythropoietin on platelet activation, thrombin generation and FVII/active FVII in patients with AMI. Thromb J 28(12):18. doi:10.1186/1477-9560-12-18
Hyseni A, Kemperman H, de Lange DW, Kesecioglu J, de Groot PG, Roest M (2014) Active von Willebrand factor predicts 28-day mortality in patients with systemic inflammatory response syndrome. Blood 123(14):2153–2156. doi:10.1182/blood-2013-08-508093
Uchino K, Hernandez AV (2012) Dabigatran association with higher risk of acute coronary events: meta-analysis of noninferiority randomized controlled trials. Arch Intern Med 172(5):397–402. doi:10.1001/archinternmed.2011.1666
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L (2009) RE-LY steering committee and investigators. dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361(12): 1139–1151. doi:10.1056/NEJMoa0905561
Krantz MJ, Kaul S (2013) The ATLAS ACS 2-TIMI 51 trial and the burden of missing data: (anti-Xa Therapy to Lower cardiovascular events in addition to standard therapy in subjects with acute coronary syndrome ACS 2-thrombolysis in myocardial infarction 51). J Am Coll Cardiol 62(9): 777–781. doi:10.1016/j.jacc.2013.05.024
Costopoulos C, Niespialowska-Steuden M, Kukreja N, Gorog DA (2013) Novel oral anticoagulants in acute coronary syndrome. Int J Cardiol 167(6):2449–2455. doi:10.1016/j.ijcard.2012.08.014
Ringwala SM, Dibattiste PM, Schneider DJ (2012) Effects on platelet function of a direct acting antagonist of coagulation factor Xa. J Thromb Thrombolysis 34(3):291–296
Wan H, Yang Y, Zhu J, Wu S, Zhou Z, Huang B, Wang J, Shao X, Zhang H (2016) An in-vitro evaluation of direct thrombin inhibitor and factor Xa inhibitor on tissue factor-induced thrombin generation and platelet aggregation: a comparison of dabigatran and rivaroxaban. Blood Coagul Fibrinolysis 27(8):882–885
Flierl U, Fraccarollo D, Micka J, Bauersachs J, Schäfer A (2013) The direct factor Xa inhibitor Rivaroxaban reduces platelet activation in congestive heart failure. Pharmacol Res 74:49–55. doi:10.1016/j.phrs.2013.05.002
Zemer-Wassercug N1, Haim M, Leshem-Lev D, Orvin KL, Vaduganathan M, Gutstein A, Kadmon E, Mager A, Kornowski R, Lev EI (2015) The effect of dabigatran and rivaroxaban on platelet reactivity and inflammatory markers. J Thromb Thrombolysis 40(3):340–346. doi:10.1007/s11239-015-1245-z
Olivier CB, Weik P, Meyer M, Weber S, Anto-Michel N, Diehl P, Zhou Q, Geisen U, Bode C, Moser M (2016) TRAP-induced platelet aggregation is enhanced in cardiovascular patients receiving dabigatran. Thromb Res 138:63–68. doi:10.1016/j.thromres.2015.10.038
Tsantes AE, Kyriakou E, Ikonomidis I, Katogiannis K, Papadakis I, Douramani P, Kopterides P, Kapsimali V, Lekakis J, Tsangaris I, Bonovas S (2016) Comparative assessment of the anticoagulant activity of Rivaroxaban and Dabigatran in patients with nonvalvular atrial fibrillation: a noninterventional study. Medicine 95(14):e3037. doi:10.1097/MD.0000000000003037
Darge A, Reynolds MR, Germano JJ (2009) Advances in atrial fibrillation ablation. J Invasive Cardiol 21:247–254
Greinacher A (2011) Platelet activation by heparin. Blood 117:4686–4687
Gao C, Boylan B, Fang J, Wilcox DA, Newman DK, Newman PJ (2011) Heparin promotes platelet responsiveness by potentiating alphaIIbbeta3-mediated outside-in signaling. Blood 117(18):4946–4952
Olivier CB, Weik P, Meyer M, Weber S, Diehl P, Bode C, Moser M, Zhou Q (2016) Dabigatran and rivaroxaban do not affect AA- and ADP-induced platelet aggregation in patients receiving concomitant platelet inhibitors. J Thromb Thrombolysis 42(2):161–166. doi:10.1007/s11239-016-1350-7
Pignatelli P, Pastori D, Bartimoccia S, Menichelli D, Vicario T, Nocella C, Carnevale R, Violi F (2016) Anti Xa oral anticoagulants inhibit in vivo platelet activation by modulating glycoprotein VI shedding. Pharmacol Res 113(Pt A):484–489. doi:10.1016/j.phrs.2016.09.035
Tsujimoto M, Kuroyanagi G, Matsushima-Nishiwaki R, Kito Y, Enomoto Y, Iida H, Ogura S, Otsuka T, Tokuda H, Kozawa O, Iwama T (2016). Factor Xa inhibitor suppresses the release of phosphorylated HSP27 from collagen-stimulated human platelets: inhibition of HSP27 phosphorylation via p44/p42 MAP Kinase. PLoS ONE 11(2):e0149077. doi:10.1371/journal.pone.0149077
Zhu Y, O’Neill S, Saklatvala J, Tassi L, Mendelsohn ME (1994) Phosphorylated HSP27 associates with the activation-dependent cytoskeleton in human platelets. Blood 84(11):3715–3723
Kato H, Adachi S, Doi T, Matsushima-Nishiwaki R, Minamitani C, Akamatsu S, Enomoto Y, Tokuda H, Otsuka T, Iwama T, Kozawa O, Ogura S (2010) Mechanism of collagen-induced release of 5-HT, PDGF-AB and sCD40L from human platelets: role of HSP27 phosphorylation via p44/p42 MAPK. Thromb Res 126(1):39–43. doi:10.1016/j.thromres.2009.12.003
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Steppich, B., Dobler, F., Brendel, L.C. et al. Effect of the FXa inhibitors Rivaroxaban and Apixaban on platelet activation in patients with atrial fibrillation. J Thromb Thrombolysis 43, 490–497 (2017). https://doi.org/10.1007/s11239-017-1495-z
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DOI: https://doi.org/10.1007/s11239-017-1495-z