Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.
Department of Hematology, Oslo University Hospital, Oslo, Norway.
Platelets. 2020;31(1):43-47. doi: 10.1080/09537104.2018.1557618. Epub 2018 Dec 20.
Factor Xa inhibitors are safe and effective alternatives to warfarin, but several studies indicate that rivaroxaban may cause a different risk profile for bleeding. For instance, while the risk of major bleeding in general may be lower with rivaroxaban than for warfarin, the risk of gastrointestinal bleeding or abnormal uterine bleeding may be higher. The underlying mechanisms for these differences are not known, and the effect of rivaroxaban on primary hemostasis is poorly understood. The aim of this study was to investigate the effect of rivaroxaban on platelet function, P-selectin and von Willebrand factor (VWF) antigen and activity. Patients with venous thrombosis assigned to 3 months of treatment due to temporary risk factors were included. Blood was collected both during (on-treatment) and 4-6 weeks after end of treatment (without treatment). The platelet reactivity was assessed by light transmission aggregometry. P-selectin was measured by an enzyme-linked immunosorbent assay and vWF antigen and activity by latex immunoagglutination assays. Platelet reactivity during on-treatment (trough- and peak concentration) was similar to values without treatment. There was a trend toward a reduction of P-selectin during rivaroxaban treatment (peak concentration) compared to value without treatment ( = 0.06). There were no differences in vWF antigen and activity between the different time-points. We found no difference in platelet reactivity or vWF antigen/activity during rivaroxaban treatment compared with values without treatment. Apart from possibly causing a reduction of P-selectin, rivaroxaban seems not to influence primary hemostasis.
Xa 因子抑制剂是安全有效的华法林替代药物，但有几项研究表明利伐沙班可能会导致不同的出血风险特征。例如，虽然利伐沙班引起大出血的总体风险可能低于华法林，但胃肠道出血或异常子宫出血的风险可能更高。这些差异的潜在机制尚不清楚，利伐沙班对原发性止血的影响也知之甚少。本研究旨在探讨利伐沙班对血小板功能、P 选择素和血管性血友病因子 (VWF) 抗原和活性的影响。患有静脉血栓形成的患者因暂时存在危险因素而被分配接受 3 个月的治疗。在治疗期间（治疗时）和治疗结束后 4-6 周（无治疗时）采集血液。通过透光比浊法评估血小板反应性。通过酶联免疫吸附试验测量 P 选择素，通过乳胶免疫凝集试验测量 vWF 抗原和活性。治疗期间（低谷和峰值浓度）的血小板反应性与无治疗时相似。与无治疗时相比，利伐沙班治疗期间（峰值浓度）P 选择素呈下降趋势（ = 0.06）。不同时间点之间 vWF 抗原和活性无差异。与无治疗时相比，我们在利伐沙班治疗期间未发现血小板反应性或 vWF 抗原/活性的差异。除了可能导致 P 选择素减少外，利伐沙班似乎不会影响原发性止血。
