Lau Yee Cheng, Xiong Qinmei, Shantsila Eduard, Lip Gregory Y H, Blann Andrew D
Institute for Cardiovascular Sciences, City Hospital, University of Birmingham, Dudley Road, Birmingham, B18 7QH, UK.
Cardiovascular Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
J Thromb Thrombolysis. 2016 Nov;42(4):535-44. doi: 10.1007/s11239-016-1399-3.
Non-vitamin K antagonist oral anticoagulants (NOACs) are replacing warfarin and heparins in several clinical situations. With varying modes of action, the effects of NOACs on thrombus formation, integrity, and lysis is unknown. To determine whether two techniques of thrombelastography (TEG) and a micro-plate assay (MPA) provide novel data on thrombus formation, integrity and lysis in those taking a NOACs compared to warfarin and a control group taking aspirin. We assessed thrombogenesis, clot integrity and fibrinolysis in blood (TEG) and plasma (MPA) from 182 atrial fibrillation patients-50 on aspirin, 50 on warfarin, and 82 on a NOAC (17 apixaban, 19 dabigatran and 46 rivaroxaban). Eleven of 16 TEG indices and 4 of 5 MPA indices differed (p ≤ 0.01) between those on aspirin, warfarin or a NOAC. Three TEG indices and 4 MPA indices differed (p < 0.01) between the NOACs. Time to initiation of clot formation was most rapid on apixaban, then rivaroxaban and slowest on dabigatran. The rate of clot formation was most rapid on dabigatran, then apixaban, and slowest on rivaroxaban. Clot density was greatest on rivaroxaban, then apixaban, but weakest on dabigatran. The rate of clot dissolution was most rapid in apixaban, then dabigatran, and slowest on rivaroxaban. The TEG and MPA identify major differences in thrombogenesis and fibrinolysis in different NOACs. These techniques may have value in investigating the effects of these drugs on haemostasis in a clinical setting, and in identifying those in need of targeted therapy.
在多种临床情况下，非维生素K拮抗剂口服抗凝药（NOACs）正在取代华法林和肝素。由于作用方式不同，NOACs对血栓形成、完整性和溶解的影响尚不清楚。为了确定血栓弹力图（TEG）和微孔板检测（MPA）这两种技术是否能提供与服用华法林的患者以及服用阿司匹林的对照组相比，服用NOACs的患者在血栓形成、完整性和溶解方面的新数据。我们评估了182例房颤患者血液（TEG）和血浆（MPA）中的血栓形成、凝块完整性和纤维蛋白溶解情况，其中50例服用阿司匹林，50例服用华法林，82例服用NOAC（17例阿哌沙班、19例达比加群和46例利伐沙班）。在服用阿司匹林、华法林或NOAC的患者之间，16项TEG指标中的11项和5项MPA指标中的4项存在差异（p≤0.01）。在NOACs之间，3项TEG指标和4项MPA指标存在差异（p<0.01）。凝块形成开始时间在阿哌沙班最快，其次是利伐沙班，在达比加群最慢。凝块形成速率在达比加群最快，其次是阿哌沙班，在利伐沙班最慢。凝块密度在利伐沙班最大，其次是阿哌沙班，但在达比加群最弱。凝块溶解速率在阿哌沙班最快，其次是达比加群，在利伐沙班最慢。TEG和MPA识别出不同NOACs在血栓形成和纤维蛋白溶解方面的主要差异。这些技术可能在临床环境中研究这些药物对止血的影响以及识别需要靶向治疗的患者方面具有价值。
