Kikuchi Shinnosuke, Tsukahara Kengo, Sakamaki Kentaro, Morita Yukiko, Takamura Takeshi, Fukui Kazuki, Endo Tsutomu, Shimizu Makoto, Sawada Reimin, Sugano Teruyasu, Himeno Hideo, Kobayashi Syunichi, Arakawa Kentaro, Mochida Yasuyuki, Tsunematsu Takashi, Shigemasa Tomohiko, Okuda Jun, Ishikawa Toshiyuki, Kimura Kazuo, Tamura Kouichi
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Division of Cardiology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.
Heart Vessels. 2019 Jun;34(6):1002-1013. doi: 10.1007/s00380-018-01324-7. Epub 2019 Jan 1.
Some experimental studies have shown that direct oral anticoagulants (DOACs) have anti-inflammatory effects. However, the interval changes in inflammatory markers in patients with non-valvular atrial fibrillation (AF) who receive DOACs remain unknown. Between July 2013 and April 2014, a total of 187 AF patients randomly assigned to receive rivaroxaban (n = 91) or dabigatran (n = 96) were assessed for eligibility. The levels of the following inflammatory markers were serially evaluated: high-sensitivity C-reactive protein, pentraxin-3, interleukin (IL)-1β, IL-6, IL-18, tumor necrosis factor-α, monocyte chemotactic protein-1, growth and differentiation factor-15, and soluble thrombomodulin (sTM). The aim in this study was to evaluate the anti-inflammatory effects of rivaroxaban and dabigatran in patients with AF, in addition to the impact of markers on bleeding events. Finally, 117 patients (rivaroxaban: n = 55, dabigatran: n = 62) were included in the analysis at 12 months. Although the interval changes in sTM levels tended to be greater in the dabigatran group [0.3 (0-0.7) vs. 0.5 (0-1.0) FU/ml, p = 0.061], there were no significant differences in the interval changes in any inflammatory marker between 2 groups. There were no significant differences in bleeding events between 2 groups. The interval changes in sTM levels were significantly greater in patients with bleeding compared with those without [0.8 (0.5-1.3) vs. 0.4 (- 0.1-0.8) FU/ml, p = 0.017]. There were no significant differences in the interval changes in any inflammatory marker between rivaroxaban and dabigatran treatments in patients with AF. The increased levels of sTM after DOACs treatment might be related to bleeding events.
一些实验研究表明，直接口服抗凝剂（DOACs）具有抗炎作用。然而，接受DOACs治疗的非瓣膜性心房颤动（AF）患者炎症标志物的间隔变化仍不清楚。在2013年7月至2014年4月期间，共评估了187例随机分配接受利伐沙班（n = 91）或达比加群（n = 96）的AF患者的 eligibility。对以下炎症标志物水平进行了连续评估：高敏C反应蛋白、五聚素-3、白细胞介素（IL）-1β、IL-6、IL-18、肿瘤坏死因子-α、单核细胞趋化蛋白-1、生长分化因子-15和可溶性血栓调节蛋白（sTM）。本研究的目的是评估利伐沙班和达比加群对AF患者的抗炎作用，以及标志物对出血事件的影响。最后，117例患者（利伐沙班：n = 55，达比加群：n = 62）在12个月时纳入分析。虽然达比加群组sTM水平的间隔变化倾向于更大[0.3（0 - 0.7）对0.5（0 - 1.0）FU/ml，p = 0.061]，但两组之间任何炎症标志物的间隔变化均无显著差异。两组之间的出血事件无显著差异。与未出血患者相比，出血患者的sTM水平间隔变化显著更大[0.8（0.5 - 1.3）对0.4（-0.1 - 0.8）FU/ml，p = 0.017]。AF患者中，利伐沙班和达比加群治疗之间任何炎症标志物的间隔变化均无显著差异。DOACs治疗后sTM水平升高可能与出血事件有关。
