Impact of dabigatran on platelet function and fibrinolysis

Argirios E. Tsantes, Elias Kyriakou, Stefanos Bonovas, Maria Chondrogianni, Christina Zompola, Chrissoula Liantinioti, Athina Simitsi, Aristeidis H. Katsanos, Maria Atta, Ignatios Ikonomidis, Violetta Kapsimali, Petros Kopterides, Georgios Tsivgoulis

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)204-208
Number of pages5
JournalJournal of the Neurological Sciences
Volume357
Issue number1-2
DOIs
StatePublished - May 30 2015

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Fibrinolysis
Blood Platelets
Thrombin
Atrial Fibrillation
Dabigatran
Thrombelastography
Cerebrovascular Disorders
Platelet Aggregation Inhibitors
Transient Ischemic Attack
Tertiary Care Centers
Anticoagulants
Area Under Curve
Therapeutics
Stroke

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Tsantes, A. E., Kyriakou, E., Bonovas, S., Chondrogianni, M., Zompola, C., Liantinioti, C., ... Tsivgoulis, G. (2015). Impact of dabigatran on platelet function and fibrinolysis. Journal of the Neurological Sciences, 357(1-2), 204-208. https://doi.org/10.1016/j.jns.2015.07.031

Impact of dabigatran on platelet function and fibrinolysis. / Tsantes, Argirios E.; Kyriakou, Elias; Bonovas, Stefanos; Chondrogianni, Maria; Zompola, Christina; Liantinioti, Chrissoula; Simitsi, Athina; Katsanos, Aristeidis H.; Atta, Maria; Ikonomidis, Ignatios; Kapsimali, Violetta; Kopterides, Petros; Tsivgoulis, Georgios.

In: Journal of the Neurological Sciences, Vol. 357, No. 1-2, 30.05.2015, p. 204-208.

Research output: Contribution to journalArticle

Tsantes, AE, Kyriakou, E, Bonovas, S, Chondrogianni, M, Zompola, C, Liantinioti, C, Simitsi, A, Katsanos, AH, Atta, M, Ikonomidis, I, Kapsimali, V, Kopterides, P & Tsivgoulis, G 2015, 'Impact of dabigatran on platelet function and fibrinolysis', Journal of the Neurological Sciences, vol. 357, no. 1-2, pp. 204-208. https://doi.org/10.1016/j.jns.2015.07.031
Tsantes AE, Kyriakou E, Bonovas S, Chondrogianni M, Zompola C, Liantinioti C et al. Impact of dabigatran on platelet function and fibrinolysis. Journal of the Neurological Sciences. 2015 May 30;357(1-2):204-208. https://doi.org/10.1016/j.jns.2015.07.031
Tsantes, Argirios E. ; Kyriakou, Elias ; Bonovas, Stefanos ; Chondrogianni, Maria ; Zompola, Christina ; Liantinioti, Chrissoula ; Simitsi, Athina ; Katsanos, Aristeidis H. ; Atta, Maria ; Ikonomidis, Ignatios ; Kapsimali, Violetta ; Kopterides, Petros ; Tsivgoulis, Georgios. / Impact of dabigatran on platelet function and fibrinolysis. In: Journal of the Neurological Sciences. 2015 ; Vol. 357, No. 1-2. pp. 204-208.
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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.",
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AU - Tsantes, Argirios E.

AU - Kyriakou, Elias

AU - Bonovas, Stefanos

AU - Chondrogianni, Maria

AU - Zompola, Christina

AU - Liantinioti, Chrissoula

AU - Simitsi, Athina

AU - Katsanos, Aristeidis H.

AU - Atta, Maria

AU - Ikonomidis, Ignatios

AU - Kapsimali, Violetta

AU - Kopterides, Petros

AU - Tsivgoulis, Georgios

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N2 - 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.

AB - 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.

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