Duarte Rita Carolina Figueiredo, Rios Danyelle Romana Alves, Figueiredo Estevão Lanna, Caiaffa José Raymundo Sollero, Silveira Francisco Resende, Lanna Rodrigo, Alves Luan Carlos Vieira, Martins Gabriela Lopes, Reis Helton José, Reis Edna Afonso, Ferreira Cláudia Natália, Sternick Eduardo Back, Campos Fernanda Magalhães Freire, das Graças Carvalho Maria
Department of Clinical and Toxicological Analysis, Faculty of Pharmacy - Federal, University of Minas Gerais, Av. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, 31270-910, Brazil.
Campus Centro Oeste Dona Lindu, Federal University of São João Del Rei, São João Del Rei, Brazil.
J Thromb Thrombolysis. 2021 Jan;51(1):47-57. doi: 10.1007/s11239-020-02126-3.
Patients with atrial fibrillation (AF) present hyperactivation of both platelets and coagulation leading to a hypercoagulable state which contributes to an increased risk of thromboembolism. Therefore, one of the main strategies for treatment of AF is prevention of these events through the use of oral anticoagulants (OAC). The aim of this study was to evaluate hemostasis as a whole in patients with non-valvular AF undergoing warfarin or rivaroxaban by thrombin generation test (TGT), in addition to monocyte-platelet aggregates (MPA), glycoprotein IIb/IIIa (GPIIb/IIIa), and platelet (PMP) and endothelium (EMP) microparticles, compared to age and sex matched controls. PT/INR for OAC use was also determined. In patients taking OAC, compared to control group, a decrease in TGT (p = 0.000 for all parameters) were observed. Patients taking warfarin showed to be more hypocoagulable, presenting lower levels of ETP (p = 0.000) and peak (p = 0.002) than patients using rivaroxaban. Patients on warfarin use with INR > 3 had also lower levels of ETP (p = 0.01) and peak (p = 0.006). A decrease in ETP (p = 0.03) and peak (p = 0.02) values was also observed in patients using rivaroxaban with PT > 21.4 s. Patients using warfarin (p = 0.000) and rivaroxaban (p = 0.000) presented lower levels of MPA in relation to control group. It was also observed in patients using warfarin, lower GPIIb/IIIa levels in relation to control group (p = 0.011). Patients taking rivaroxaban (p = 0.003) and warfarin (p = 0.001) had higher PMP levels compared to control group. There was no difference in levels of EMP between the groups (p = 0.0536). The present study reinforces the usefulness of OAC in AF, which decisively contribute to a better management of the disease preventing possible complications.
心房颤动（AF）患者存在血小板和凝血的过度激活，导致高凝状态，这增加了血栓栓塞的风险。因此，治疗AF的主要策略之一是通过使用口服抗凝剂（OAC）预防这些事件。本研究的目的是，除了检测单核细胞 - 血小板聚集体（MPA）、糖蛋白IIb/IIIa（GPIIb/IIIa）、血小板（PMP）和内皮（EMP）微粒外，通过凝血酶生成试验（TGT）评估接受华法林或利伐沙班治疗的非瓣膜性AF患者的整体止血情况，并与年龄和性别匹配的对照组进行比较。还测定了使用OAC时的PT/INR。与对照组相比，服用OAC的患者TGT降低（所有参数p = 0.000）。服用华法林的患者比使用利伐沙班的患者更易出现低凝状态，表现为较低的内源性凝血酶潜能（ETP，p = 0.000）和峰值（p = 0.002）。INR>3的服用华法林的患者ETP（p = 0.01）和峰值（p = 0.006）水平也较低。PT>21.4秒的使用利伐沙班的患者ETP（p = 0.03）和峰值（p = 0.02）值也降低。与对照组相比，使用华法林（p = 0.000）和利伐沙班（p = 0.000）的患者MPA水平较低。在使用华法林的患者中还观察到，与对照组相比GPIIb/IIIa水平较低（p = 0.011）。与对照组相比，服用利伐沙班（p = 0.003）和华法林（p = 0.001）的患者PMP水平较高。各组间EMP水平无差异（p = 0.0536）。本研究强化了OAC在AF中的有用性，其对疾病的更好管理具有决定性作用，可预防可能的并发症。
