PDF(Pubmed)
Abstract：
Insufficient data exist regarding the investigation of the impact of novel oral anticoagulants (NOACs) on coagulation activation biomarkers in the context of left atrial appendage closure (LAAC) and device-related thrombosis (DRT). The study was designed to investigate the changes and presence of coagulation activation biomarkers between different antithrombotic strategies following LAAC. A total of 120 nonvalvular atrial fibrillation patients intolerant of long-term anticoagulants, who underwent successful WATCHMAN closure implantation, were enrolled (rivaroxaban, n = 82; dabigatran, n = 38). Blood samples were obtained from left atrium (LA) and left atrial appendage (LAA) during the operation and fasting blood samples on the same day of LAAC and 45 days after discharge. The biochemical indicators, thrombin-antithrombin complex (TAT), soluble P-selectin (sP-selectin), von Willebrand factor (vWF), and CD40 ligand (CD40L), were measured by enzyme-linked immunosorbent assay. The primary endpoints of this study were the efficacy and safety characteristics of different antithrombotic strategies, including DRT incidence, stroke or transient ischemic attack, systemic embolism, and clinical major and nonmajor bleeding complications during the follow-up of 180 days. The results revealed that TAT, vWF, sP-selectin, and CD40L levels in vein were significantly reduced by 2.4% (p = 0.043), 5.0% (p < 0.001), 8.7% (p < 0.001), and 2.5% (p = 0.043) from their baseline levels after rivaroxaban treatment. Conversely, no significant changes were detected in the dabigatran group. Furthermore, the plasma levels of platelet activation biomarkers (CD40L and sP-selectin) in both LA and LAA groups were significantly lower after anticoagulation with rivaroxaban, as compared to dabigatran treatment (CD40L: 554.62 ± 155.54 vs. 445.02 ± 130.04 for LA p = 0.0013, 578.51 ± 156.28 vs. 480.13 ± 164.37 for LAA p = 0.0052; sP-selectin: 2849.07 ± 846.69 vs. 2225.54 ± 799.96 for LA p = 0.0105, 2915.52 ± 1402.40 vs. 2203.41 ± 1061.67 for LAA p = 0.0022). Notably, the present study suggests that rivaroxaban may be more effective in the prevention of DRT for patients undergoing LAAC.
摘要：
关于新型口服抗凝剂（NOAC）对左心耳封堵（LAAC）和装置相关血栓形成（DRT）的凝血激活生物标志物的影响的研究数据不足。该研究旨在研究LAAC后不同抗血栓形成策略之间凝血激活生物标志物的变化和存在。共有120例非瓣膜性心房颤动患者不能长期耐受抗凝药,他接受了成功的WATCHMAN闭合植入，被登记(利伐沙班，n=82；达比加群，n=38）。手术期间从左心房（LA）和左心耳（LAA）采集血样，并在LAAC当天和出院后45天空腹采集血样。生化指标,凝血酶-抗凝血酶复合物(TAT),可溶性P-选择素（sP-选择素），血管性血友病因子(vWF)，和CD40配体（CD40L），通过酶联免疫吸附测定。这项研究的主要终点是不同抗血栓策略的疗效和安全性特征，包括DRT发病率，中风或短暂性脑缺血发作，全身性栓塞,以及180天随访期间的临床主要和非主要出血并发症。结果显示，TAT，vWF,sP-选择素,和CD40L水平在静脉显着降低了2.4％（p=0.043），5.0%(p<0.001)，8.7%(p<0.001)，利伐沙班治疗后基线水平为2.5%(p=0.043)。相反，达比加群组未检测到显著变化.此外，利伐沙班抗凝后，LA组和LAA组的血小板活化生物标志物（CD40L和sP-选择素）的血浆水平均显着降低，与达比加群治疗相比（CD40L：554.62±155.54vs.445.02±130.04对于LAp=0.0013，578.51±156.28与480.13±164.37对于LAAp=0.0052；sP-选择素：2849.07±846.69vs.2225.54±799.96对于LAp=0.0105，2915.52±1402.40与2203.41±1061.67对于LAAp=0.0022)。值得注意的是,本研究提示,对于接受LAAC的患者,利伐沙班可能更有效地预防DRT.
