Neira Víctor, Corbalán Ramón, Pereira Jaime, Panes Olga, Garayar Bernardita, Aizman Andrés, Llevaneras Silvana, Villarroel Luis
División de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile.
Departamento de Hematología y Oncología, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Med Chil. 2016 Sep;144(9):1103-1111. doi: 10.4067/S0034-98872016000900002.
Atrial fibrillation (AF) generates a hypercoagulable state with an increased thrombin generation and raised levels of thrombin-antithrombin complexes, which results in a high risk of stroke and thromboembolism.
To evaluate the anticoagulant effect of rivaroxaban by anti-Xa factor activity and its correlation with thrombin-antithrombin complexes, thrombin generation and prothrombin time in patients newly diagnosed with non-valvular AF.
Prospective study in patients with indication of anticoagulation. Demographic variables, cardiovascular risk factors, CHA2DS2-VASc and HAS-BLED scores were recorded. Blood samples were taken at baseline, at 3 and 24 hours after the administration of the drug and at 30 days. Rivaroxaban levels, anti-Xa activity, prothrombin time, thrombin generation and plasma levels of thrombin-antithrombin complexes were determined.
We studied 20 patients aged 76.3 ± 8.0 years (60% female) with a CHA2DS2-VASc score > 2 points. The anti-Xa factor activity correlated with rivaroxaban plasma levels at 3 hours (r = 0.61, p < 0.01), at 24 hours (r = 0.85, p < 0.01) and at 30 days (r = 0.99, p < 0.01), with prothrombin time at 3 hours (r = -0.86, p = 0.019) and at 30 days (r = -0.63, p = 0.02) and with a sustained decrease in thrombin generation at 30 days of follow-up (r = -0.74, p < 0.01). There was no correlation with thrombin-antithrombin complexes (r = -0.02, p = 0.83).
Rivaroxaban consistently inhibited the mild pro-coagulant state found in newly diagnosed non-valvular AF patients through the first 24 hours and this effect was maintained at 30 days. Plasma levels of the drug correlated with anti-Xa factor activity, thrombin generation and prothrombin time.
心房颤动（AF）会产生高凝状态，凝血酶生成增加，凝血酶 - 抗凝血酶复合物水平升高，这会导致中风和血栓栓塞的高风险。
通过抗Xa因子活性评估利伐沙班的抗凝效果，及其与新诊断的非瓣膜性AF患者的凝血酶 - 抗凝血酶复合物、凝血酶生成和凝血酶原时间的相关性。
对有抗凝指征的患者进行前瞻性研究。记录人口统计学变量、心血管危险因素、CHA2DS2 - VASc和HAS - BLED评分。在基线、给药后3小时和24小时以及30天时采集血样。测定利伐沙班水平、抗Xa活性、凝血酶原时间、凝血酶生成和凝血酶 - 抗凝血酶复合物的血浆水平。
我们研究了20例年龄为76.3±8.0岁（60%为女性）、CHA2DS2 - VASc评分>2分的患者。抗Xa因子活性在3小时（r = 0.61，p < 0.01）、24小时（r = 0.85，p < 0.01）和30天（r = 0.99，p < 0.01）时与利伐沙班血浆水平相关，在3小时（r = -0.86，p = 0.019）和30天（r = -0.63，p = 0.02）时与凝血酶原时间相关，在随访30天时与凝血酶生成的持续降低相关（r = -0.74，p < 0.01）。与凝血酶 - 抗凝血酶复合物无相关性（r = -0.02，p = 0.83）。
利伐沙班在最初24小时内持续抑制新诊断的非瓣膜性AF患者中发现的轻度促凝状态，且这种作用在30天时得以维持。药物的血浆水平与抗Xa因子活性、凝血酶生成和凝血酶原时间相关。
