title: Reversal of rivaroxaban-induced alterations on hemostasis by different coagulation factor concentrates – in vitro studies with steady and circulating human blood.
abstract: BACKGROUND
  Despite the good safety of rivaroxaban, there is limited information on strategies for urgent reversal of its antihemostatic effects.
  
  
  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.
authors.affiliation: Department of Haemotherapy and Haemostasis, Hospital Clinic, Centre of Biomedical Diagnosis, Institute of Biomedical Research August Pi i Sunyer, University of Barcelona, Spain.
authors.forename: Gines
authors.initials: G
authors.lastname: Escolar
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arellano-Rodrigo
authors.forename: Irene
authors.initials: I
authors.lastname: Lopez-Vilchez
authors.forename: Patricia
authors.initials: P
authors.lastname: Molina
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Joan Carles
authors.initials: JC
authors.lastname: Reverter
authors.forename: Xavier
authors.initials: X
authors.lastname: Carne
authors.forename: Joan
authors.initials: J
authors.lastname: Cid
authors.forename: Jaume
authors.initials: J
authors.lastname: Villalta
authors.forename: Dolors
authors.initials: D
authors.lastname: Tassies
authors.forename: Ana M
authors.initials: AM
authors.lastname: Galan
authors.forename: Maribel
authors.initials: M
authors.lastname: Diaz-Ricart
mesh_terms: D001779:Blood Coagulation Factors / Q000494:pharmacology*; D005169:Factor VIII / Q000494:pharmacology*; D015944:Factor VIIIa / Q000494:pharmacology*; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D000069552:Rivaroxaban / Q000494:pharmacology*
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D015944:Factor VIIIa; C078147:F8 protein, human; D005169:Factor VIII; D000069552:Rivaroxaban