Abstract：
UNASSIGNED: There are important pharmacological differences between direct oral anticoagulants (DOAC) and a deeper knowledge of how they influence different aspects of hemostasis in patients on treatment is desirable.
UNASSIGNED: Blood samples from patients on dabigatran (n = 23), rivaroxaban (n = 26), or apixaban (n = 20) were analyzed with a fibrin network permeability assay, a turbidimetric clotting and lysis assay, the calibrated automated thrombogram (CAT), plasma levels of thrombin-antithrombin complex (TAT) and D-dimer, as well as DOAC concentrations, PT-INR and aPTT. As a comparison, we also analyzed samples from 27 patients on treatment with warfarin.
UNASSIGNED: Patients on dabigatran had a more permeable fibrin network, longer lag time (CAT and turbidimetric assay), and lower levels of D-dimer in plasma, compared with patients on rivaroxaban- and apixaban treatment, and a more permeable fibrin network than patients on warfarin. Clot lysis time was slightly longer in patients on dabigatran than in patients on rivaroxaban. Warfarin patients formed a more permeable fibrin network than patients on apixaban, had longer lag time than patients on rivaroxaban (CAT assay), and lower peak thrombin and ETP compared to patients on treatment with both FXa-inhibitors.
UNASSIGNED: Results from this study indicate dabigatran treatment is a more potent anticoagulant than apixaban and rivaroxaban. However, as these results are not supported by clinical data, they are probably more related to the assays used and highlight the difficulty of measuring and comparing the effect of anticoagulants.
UNASSIGNED: Blood samples from patients on dabigatran (n = 23), rivaroxaban (n = 26), or apixaban (n = 20) were analyzed with a fibrin network permeability assay, a turbidimetric clotting and lysis assay, the calibrated automated thrombogram (CAT), plasma levels of thrombin-antithrombin complex (TAT) and D-dimer, as well as DOAC concentrations, PT-INR and aPTT. As a comparison, we also analyzed samples from 27 patients on treatment with warfarin.
UNASSIGNED: Patients on dabigatran had a more permeable fibrin network, longer lag time (CAT and turbidimetric assay), and lower levels of D-dimer in plasma, compared with patients on rivaroxaban- and apixaban treatment, and a more permeable fibrin network than patients on warfarin. Clot lysis time was slightly longer in patients on dabigatran than in patients on rivaroxaban. Warfarin patients formed a more permeable fibrin network than patients on apixaban, had longer lag time than patients on rivaroxaban (CAT assay), and lower peak thrombin and ETP compared to patients on treatment with both FXa-inhibitors.
UNASSIGNED: Results from this study indicate dabigatran treatment is a more potent anticoagulant than apixaban and rivaroxaban. However, as these results are not supported by clinical data, they are probably more related to the assays used and highlight the difficulty of measuring and comparing the effect of anticoagulants.
摘要：
■直接口服抗凝剂（DOAC）之间存在重要的药理学差异，并且需要更深入地了解它们如何影响患者止血的不同方面。
■达比加群患者的血液样本（n=23），利伐沙班（n=26），或阿哌沙班(n=20)用纤维蛋白网络通透性测定法分析，比浊法凝血和溶解试验，校准的自动血栓图（CAT），凝血酶-抗凝血酶复合物（TAT）和D-二聚体的血浆水平，以及DOAC浓度，PT-INR和aPTT。作为比较,我们还分析了27例接受华法林治疗的患者的样本.
■服用达比加群的患者具有更可渗透的纤维蛋白网络，较长的滞后时间(CAT和比浊法)，血浆中D-二聚体水平较低,与利伐沙班和阿哌沙班治疗的患者相比，和比服用华法林的患者更具渗透性的纤维蛋白网络。达比加群患者的凝块溶解时间略长于利伐沙班患者。华法林患者形成了比阿哌沙班患者更具渗透性的纤维蛋白网络，比利伐沙班（CAT测定）患者的滞后时间更长，与使用两种FXa抑制剂治疗的患者相比，峰值凝血酶和ETP较低。
■这项研究的结果表明，达比加群治疗比阿哌沙班和利伐沙班更有效。然而,因为这些结果没有临床数据支持，它们可能与所用的检测方法更相关,并突出了测量和比较抗凝剂效果的难度.
■达比加群患者的血液样本（n=23），利伐沙班（n=26），或阿哌沙班(n=20)用纤维蛋白网络通透性测定法分析，比浊法凝血和溶解试验，校准的自动血栓图（CAT），凝血酶-抗凝血酶复合物（TAT）和D-二聚体的血浆水平，以及DOAC浓度，PT-INR和aPTT。作为比较,我们还分析了27例接受华法林治疗的患者的样本.
■服用达比加群的患者具有更可渗透的纤维蛋白网络，较长的滞后时间(CAT和比浊法)，血浆中D-二聚体水平较低,与利伐沙班和阿哌沙班治疗的患者相比，和比服用华法林的患者更具渗透性的纤维蛋白网络。达比加群患者的凝块溶解时间略长于利伐沙班患者。华法林患者形成了比阿哌沙班患者更具渗透性的纤维蛋白网络，比利伐沙班（CAT测定）患者的滞后时间更长，与使用两种FXa抑制剂治疗的患者相比，峰值凝血酶和ETP较低。
■这项研究的结果表明，达比加群治疗比阿哌沙班和利伐沙班更有效。然而,因为这些结果没有临床数据支持，它们可能与所用的检测方法更相关,并突出了测量和比较抗凝剂效果的难度.
