Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey.
Department of Biochemistry, Bursa Postgraduate Hospital, Bursa, Turkey.
Naunyn Schmiedebergs Arch Pharmacol. 2023 Nov;396(11):3221-3232. doi: 10.1007/s00210-023-02533-2. Epub 2023 May 20.
We investigated in vitro the management of intraprocedural anticoagulation in patients requiring immediate percutaneous coronary intervention (PCI) while using regular direct oral anticoagulants (DOACs). Twenty-five patients taking 20 mg of rivaroxaban once daily comprised the study group, while five healthy volunteers included the control group. In the study group, a beginning (24 h after the last rivaroxaban dose) examination was performed. Then, the effects of basal and four different anticoagulant doses (50 IU/kg unfractionated heparin (UFH), 100 IU/kg UFH, 0.5 mg/kg enoxaparin, and 1 mg/kg enoxaparin) on coagulation parameters were investigated at the 4th and 12th h following rivaroxaban intake. The effects of four different anticoagulant doses were evaluated in the control group. The anticoagulant activity was assessed mainly by anti-factor Xa (anti-Xa) levels. Beginning anti-Xa levels were significantly higher in the study group than in the control group (0.69 ± 0.77 IU/mL vs. 0.20 ± 0.14 IU/mL; p < 0.05). The study group's 4th and 12th-h anti-Xa levels were significantly higher than the beginning level (1.96 ± 1.35 IU/mL vs. 0.69 ± 0.77 IU/mL; p < 0.001 and 0.94 ± 1.21 IU/mL vs. 0.69 ± 0.77 IU/mL; p < 0.05, respectively). Anti-Xa levels increased significantly in the study group with the addition of UFH and enoxaparin doses at the 4th and 12th h than the beginning (p < 0.001 at all doses). The safest anti-Xa level (from 0.94 ± 1.21 to 2.00 ± 1.02 IU/mL) was achieved 12 h after rivaroxaban with 0.5 mg/kg enoxaparin. Anticoagulant activity was sufficient for urgent PCI at the 4th h after rivaroxaban treatment, and additional anticoagulant administration may not be required at this time. Twelve hours after taking rivaroxaban, administering 0.5 mg/kg of enoxaparin may provide adequate and safe anticoagulant activity for immediate PCI. This experimental study result should confirm with clinical trials (NCT05541757).
我们研究了在使用常规直接口服抗凝剂（DOACs）的情况下，需要立即进行经皮冠状动脉介入治疗（PCI）的患者术中抗凝管理。25 名每日服用 20 毫克利伐沙班的患者组成研究组，5 名健康志愿者组成对照组。在研究组中，在最后一次利伐沙班剂量后 24 小时进行了初步检查。然后，在服用利伐沙班后第 4 和第 12 小时，研究组检测了基础和四种不同抗凝剂量（50 IU/kg 未分级肝素（UFH）、100 IU/kg UFH、0.5 mg/kg 依诺肝素和 1 mg/kg 依诺肝素）对凝血参数的影响。在对照组中评估了四种不同抗凝剂量的效果。抗凝活性主要通过抗因子 Xa（抗-Xa）水平来评估。研究组的起始抗-Xa 水平明显高于对照组（0.69 ± 0.77 IU/mL 比 0.20 ± 0.14 IU/mL；p < 0.05）。研究组第 4 和第 12 小时的抗-Xa 水平明显高于起始水平（1.96 ± 1.35 IU/mL 比 0.69 ± 0.77 IU/mL；p < 0.001 和 0.94 ± 1.21 IU/mL 比 0.69 ± 0.77 IU/mL；p < 0.05，分别）。与起始水平相比，在第 4 和第 12 小时，研究组中随着 UFH 和依诺肝素剂量的增加，抗-Xa 水平显著增加（所有剂量均 p < 0.001）。在利伐沙班后 12 小时，给予 0.5 mg/kg 依诺肝素时，达到最安全的抗-Xa 水平（从 0.94 ± 1.21 至 2.00 ± 1.02 IU/mL）。在利伐沙班治疗后第 4 小时，抗凝活性足以进行紧急 PCI，此时可能不需要额外的抗凝治疗。在服用利伐沙班 12 小时后，给予 0.5 mg/kg 的依诺肝素可能会为立即进行 PCI 提供足够且安全的抗凝活性。这项实验研究结果应与临床试验（NCT05541757）进行确认。
