Highlights
- •The fibrinolytic/antiplatelet activity of DE in secondary IS prevention is unknown.
- •DE was associated with lysis index reduction and PFA-100 CEPI prolongation.
- •We also highlight ETP as an alternative option in DE monitoring.
- •DE antiplatelet/fibrinolytic effects require further investigation in clinical trials.
Abstract
Background
We sought to evaluate the potential enhanced fibrinolytic and antiplatelet activity
of dabigatran etexilate (DE) due to decreased thrombin levels in patients with stroke
or transient ischemic attack and non-valvular atrial fibrillation (NVAF).
Methods
Consecutive patients with cerebrovascular diseases and NVAF that were treated with
DE in a tertiary university hospital. Fibrinolysis and platelet function were assessed
by thromboelastometry (ROTEM) and platelet function analyzer (PFA)-100, respectively,
before and after treatment with DE. Conventional coagulation tests, endogenous thrombin
potential (ETP) and hemoclot thrombin inhibitors (HTI), were also performed in order
to detect any possible correlation between dabigatran plasma levels, its anticoagulant
activity and the intensity of platelet dysfunction or fibrinolysis.
Results
A total of nineteen patients fulfilled our inclusion criteria (mean age 62.3 ± 7.2 years; 47% males; median CHADS2-score: 3; interquartile range: 2–4). DE treatment was associated with a significant
reduction of the lysis index (LI60) at 60 min (p = 0.036), and prolongation of the PFA-100 CEPI closure time (p = 0.024). After dabigatran treatment, abnormal PFA-100 results were obtained in two
patients (11%, 95% CI: 2%–33%). DE levels (determined by HTI) were strongly inversely
correlated (rho = –0.85; p < 0.001) with the area under the curve (AUC) values in ETP assay. Νo association was
found between HTI and PFA-100 CEPI CT (p = 0.64), or LI60 measurements (p = 0.60).
Conclusions
Our findings indicate that DE might affect platelet function and fibrinolysis and
highlight the potential role of ETP as an alternative option in DE monitoring. The
intensity and clinical relevance of DE antiplatelet and fibrinolytic effects require
further investigation.
Keywords
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Article info
Publication history
Published online: July 22, 2015
Accepted:
July 21,
2015
Received in revised form:
July 6,
2015
Received:
May 30,
2015
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
