Differences between activities of coagulation factors after one month of therapy with different direct oral anticoagulant in pulmonary embolism patients. (8th November 2018)

• Record Type: Journal Article
• Authors: Dzudovic, Jelena; Dzudovic, Boris; Subota, Vesna; Antunovic, Marko; Stavric, Milena; Subotic, Bojana; Obradovic, Slobodan
• Is Part Of: Journal of clinical pharmacy and therapeutics. Volume 44:Number 2(2019)
• Page Start: 236
• Page End: 242
• Publication Date: 2018-11-08
• Subjects: Clinical pharmacology -- Periodicals; Chemotherapy -- Periodicals; 615
• DOI: 10.1111/jcpt.12776
• Languages: English
• ISSNs: 0269-4727

Abstract

Summary: What is known and Objective: Direct oral anticoagulants (DOACs) are frequently used for the treatment of pulmonary embolism (PE), but both clinical and laboratory data comparing their efficacy and safety are conflicting. This study investigated and compared the impact of three DOACs (apixaban, rivaroxaban and dabigatran) on coagulation cascade in acute PE patients. Methods: After the initial treatment, acute PE patients were randomly allocated to one of three groups, and treatment continued using one of the three DOACs. Following 1 month of treatment, the activity of factors II, VII and VIII, as well as protein C, antithrombin, D‐dimer and fibrinogen, were measured, and the values were compared between the groups. Results and Discussion: One hundred consecutive PE patients were included. The mean values for the activity of factors II and VII and protein C were higher in patients on apixaban than in patients on rivaroxaban (1.45 ± 1.12 (IU/mL) vs 1.13 ± 0.92 (IU/mL), P < 0.001; 1.24 ± 1.10 (IU/mL) vs 1.05 ± 0.98 (IU/mL), P = 0.024 and 1.15 ± 0.62 vs 1.02 ± 0.68 (IU/mL), P = 0.019, respectively). The mean of factor II activity and the median of factor VIII activity were also significantly higher in patients on apixaban than in patients on dabigatran (1.45 ± 1.12 vs 1.20 ± 0.96 (IU/mL), P = 0.003 and 2.9 (2.0‐4.0) vs 2.1 (1.5‐2.7) (IU/mL), P = 0.001, respectively). No difference was noticed in D‐dimer concentrations, or in the activity of the other factors measured. Additionally, no difference was noticed between the rivaroxaban and dabigatran groups. What is new and Conclusion: Apixaban had a significantly higher thrombin activity, above the laboratory determined normal range, compared to patients on rivaroxaban and dabigatran. This higher thrombin activity in patients on apixaban may contribute to a better haemostatic response during the therapy or increased prothrombotic state after therapy interruption. Abstract : This cross‐sectional study followed‐up patients who continued the treatment with one of the DOACs (rivaroxaban, apixaban or dabigatran) after the initial treatment of acute pulmonary embolism. After one month on stable therapy, the activity of certain coagulation‐cascade factors such as II, VII, VIII, protein C, antithrombin as well as the serum concentration of fibrinogen and D‐dimer were measured. The main finding was that patients on apixaban had a significantly higher activity of factor II then patients on rivaroxaban and dabigatran whereas no difference in the concentrations of fibrinogen and D‐dimer existed.