Reversal of rivaroxaban-induced alterations on hemostasis by different coagulation factor concentrates - In vitro studies with steady and circulating human blood -

BACKGROUND: Despite the good safety of rivaroxaban, there is limited information on strategies for urgent reversal of its antihemostatic effects.Methods and Results:Alterations of hemostasis induced by rivaroxaban (230 ng/ml) were assessed by using several tests applied to steady and circulating hum...

Descripción completa

Detalles Bibliográficos
Autores: Escolar Albaladejo, Ginés, Arellano Rodrigo, Eduardo, López Vilchez, Irene, Molina, Patricia, Sanchis Forés, Juan, Reverter Calatayud, Juan Carlos, Carné Cladellas, Xavier, Cid Vidal, Joan, Villalta i Blanch, Jaume, Tàssies Penella, María Dolores, Galan, Ana M., Diaz Ricart, M. Isabel
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2015
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/113934
Acceso en línea:https://hdl.handle.net/2445/113934
Access Level:acceso abierto
Palabra clave:Coagulació sanguínia
Hemostàsia
Assaigs clínics de medicaments
Medicaments
Blood coagulation
Hemostasis
Drug testing
Drugs
Descripción
Sumario:BACKGROUND: Despite the good safety of rivaroxaban, there is limited information on strategies for urgent reversal of its antihemostatic effects.Methods and Results:Alterations of hemostasis induced by rivaroxaban (230 ng/ml) were assessed by using several tests applied to steady and circulating human blood. Effects on thrombin generation (TG) and thromboelastometry (TEM) parameters were measured. Modifications in platelet adhesive, aggregating and procoagulant activities were evaluated in studies with circulating blood. The potential reversal of prothrombin complex concentrates (PCCs; 50 IU/kg), activated PCCs (aPCCs; 75 IU/kg), or recombinant factor VIIa (rFVIIa; 270 μg/kg) was evaluated. Impairment of TG parameters induced by rivaroxaban were corrected by the different concentrates (aPCC≥PCC>rFVIIa). Prolonged clotting times and reduced clot firmness caused by rivaroxaban on TEM tests were improved by different concentrates (rFVIIa≥aPCC>PCC). Rivaroxaban significantly reduced platelets and fibrin interactions with damaged vascular surfaces in perfusion studies. While alterations of platelet interactions were favourably counteracted by rFVIIa or aPCCs, reductions in fibrin formation were only partially restored by the different factor concentrates (rFVIIa>aPCC≥PCC). CONCLUSIONS: Rivaroxaban-induced alterations on coagulation parameters measured through assays performed under static conditions were easily reversed by the different concentrates. Studies under flow conditions revealed that these concentrates normalized the action of rivaroxaban on platelets, and significantly improved fibrin formation; although in the later case, levels were not restored to the pre-treatment value. (Circ J 2015; 79: 331-338).

Similares en LA Referencia