Why the study?
How does dabigatran etexilate compare to acenocoumarol in affecting laboratory coagulation assays in patients with nonvalvular atrial fibrillation?
How does dabigatran etexilate compare to acenocoumarol in affecting laboratory coagulation assays in patients with nonvalvular atrial fibrillation?
Endogenous thrombin potential (ETP) correlates with dabigatran levels and may be useful for estimating its anticoagulant activity, though acenocoumarol affects thrombin generation more strongly.
Supports ETP for estimating dabigatran activity in AF; hypothesis-generating and should not yet change practice.
BACKGROUND: Our aim was to identify laboratory assays in order to assess the anticoagulant effects of dabigatran etexilate (DE). METHODS: Twenty patients with nonvalvular atrial fibrillation treated on DE (110 mg per os twice daily) and 20 on acenocoumarol were studied. Conventional coagulation tests, endogenous thrombin potential (ETP), thromboelastometry (ROTEM), epinephrine-induced light transmission aggregometry (LTA), and Hemoclot Thrombin Inhibitors (HTI) were performed in all patients. RESULTS: In ROTEM analysis, the lysis index at 60 minutes was significantly lower in patients receiving DE (P = .011). In LTA, patients on DE showed decreased aggregation compared to those on acenocoumarol, marginally insignificant (P = .068). Regarding ETP, acenocoumarol affected thrombin generation more than dabigatran (area under the curve [AUC], P < .001), while statistically significant associations were detected between dabigatran levels, as determined by the HTI assay, and almost all parameters of ETP assay (AUC, P < .001). CONCLUSION: The role of ETP in estimating anticoagulant activity of dabigatran possibly requires further research.
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Kyriakou et al. (2014) studied this question.
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