74566First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China.
562131Binzhou Medical University Hospital, Shandong, China.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211044722. doi: 10.1177/10760296211044722.
Novel oral anticoagulants and warfarin are widely used for stroke prevention in patients with atrial fibrillation. The anticoagulation status of patients receiving warfarin or rivaroxaban has been studied. In this study, we aimed to evaluate the effect of dabigatran and warfarin on preventing thrombin generation (TG).
This retrospective study enrolled 237 nonvalvular atrial fibrillation (NVAF) subjects treated with 110 mg dabigatran etexilate twice daily and 224 NVAF patients received adjusted-dose warfarin (international normalized ratio [INR] of 2 to 3)). Coagulation assays, prothrombin fragment 1 + 2 (F), calibrated automated thrombogram, and thrombin-antithrombin complex (TAT) were detected at the steady state.
Activated partial thromboplastin time (APTT), antithrombin III activity, fibrinogen, and lag time showed no difference between the two groups. Compared to the dabigatran group, prothrombin time and INR values were higher in the warfarin group (all < .001). Thrombin time, endogenous thrombin potential, peak TG (C), F, and TAT were lower in the warfarin group. The inhibition of TG was still stronger in the warfarin group when the patients were divided into subgroups.
Conventional coagulation assays are suboptimal for assessing the coagulation status of dabigatran. TG could be used as supplementary assays to evaluate the anticoagulation effect of oral anticoagulants. Our results suggest that warfarin may inhibit TG more aggressively than dabigatran in patients regardless of age and kidney function.
新型口服抗凝剂和华法林广泛用于预防房颤患者的中风。已经研究了接受华法林或利伐沙班治疗的患者的抗凝状态。在这项研究中，我们旨在评估达比加群酯和华法林预防凝血酶生成（TG）的效果。
这项回顾性研究纳入了 237 名每日两次接受 110 毫克达比加群酯治疗的非瓣膜性房颤（NVAF）患者和 224 名接受调整剂量华法林（国际标准化比值[INR]为 2 至 3）治疗的 NVAF 患者。在稳定状态下检测凝血测定、凝血酶原片段 1+2（F）、校准自动血栓图和凝血酶-抗凝血酶复合物（TAT）。
两组之间的活化部分凝血活酶时间（APTT）、抗凝血酶 III 活性、纤维蛋白原和滞后时间无差异。与达比加群酯组相比，华法林组的凝血酶时间和 INR 值更高（均<.001）。华法林组的凝血酶时间、内源性凝血酶潜能、最大 TG（C）、F 和 TAT 较低。当将患者分为亚组时，华法林组对 TG 的抑制作用仍然更强。
常规凝血测定不适于评估达比加群酯的凝血状态。TG 可作为评估口服抗凝剂抗凝效果的辅助检测。我们的结果表明，无论年龄和肾功能如何，华法林可能比达比加群酯更能抑制 TG。
