title: Effects of dabigatran in vitro on thrombin biomarkers by Calibrated Automated Thrombography in patients after ischemic stroke.
abstract: Randomized trials suggest superior and safe stroke prevention in patients with atrial fibrillation after anticoagulation with dabigatran (D) at a 150 mg BID as described in the RE-LY prospective randomized open-label trial when compared to warfarin. Thrombin generation (TG) is a cornerstone of coagulation cascade, and represents a critical biomarker of atherothrombosis. We, therefore, sought to define the effect of D in escalating concentrations on the time course of TG using the Calibrated Automated Thrombogram(®) (CAT) technology in patients after ischemic stroke. Serial plasma samples were obtained from 20 patients with ischemic stroke documented by neuroimaging, who were treated with aspirin for at least 30 days. The impact of 0.1, 0.23, 0.46, 0.69 mM D in platelet-poor plasma (PPP) on TG indices was assessed using fluorogenic substrate CAT device. The following integrated CAT parameters: TGmax, start time (t-start) peak time (t-peak), and mean time (t-mean) were calculated for each D dose and compared with those of the vehicle. Preincubation of PPP with D resulted in dose-dependent significant inhibition of most TG indices. The TGmax was gradually reduced from 447 ± 21 nM at baseline and reach significance for 0.46 mM D (355 ± 44 nM, P = 0.03); and decreased further at 0.69 mM D to 302 ± 27 nM (P = 0.01). The t-peak has been achieved 2-3 times later than after vehicle already at 0.23 nM D. The t-start was delayed 3-4 fold starting from 0.23 mM concentration of D (P < 0.001 for all), but not different from D 0.1 mM (1.5 vs. 1.6; P = 0.34). The t-mean was not significantly affected by D. D in vitro impacts indices of TG predominantly by dose dependent inhibition of endogenous TG, and delayed thrombin production. This preliminary evidence, while intriguing, requires confirmation in post-stroke patients receiving orally dosed D in order to determine whether these findings are clinically relevant.
authors: Johns Hopkins University, Baltimore, MD, USA. heartdrug@aol.com
authors: Victor
authors: V
authors: Serebruany
authors: Yanti
authors: Y
authors: Sani
authors: Donald
authors: D
authors: Lynch
authors: Alex
authors: A
authors: Schevchuck
authors: Stan
authors: S
authors: Svetlov
authors: Alan
authors: A
authors: Fong
authors: Lionel
authors: L
authors: Thevathasan
authors: Dan
authors: D
authors: Hanley
mesh_terms: D000368:Aged; D001331:Automation; D001562:Benzimidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy; D002138:Calibration; D000069604:Dabigatran; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020521:Stroke / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy; D013917:Thrombin / Q000037:antagonists & inhibitors* / Q000378:metabolism*; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D001562:Benzimidazoles; D015415:Biomarkers; D015091:beta-Alanine; D013917:Thrombin; D000069604:Dabigatran