title: Comparative Assessment of the Anticoagulant Activity of Rivaroxaban and Dabigatran in Patients With Nonvalvular Atrial Fibrillation: A Noninterventional Study.
abstract: There is a shortage of data in everyday clinical practice about the anticoagulant effects caused by the new oral anticoagulants (NOAs). Our aim was to estimate the intensity of anticoagulant activity induced by rivaroxaban 20 mg qd and dabigatran 110 mg bid among patients with nonvalvular atrial fibrillation (NV-AF).We studied 20 patients with NV-AF treated with dabigatran, and 20 patients treated with rivaroxaban. We performed conventional coagulation tests, thrombin generation (TG) test, thromboelastometry (ROTEM), and epinephrine-induced light transmission aggregometry (LTA) in all 40 patients and 20 controls. Hemoclot Thrombin Inhibitors (HTI) and Factor Xa Direct Inhibitor (DiXaI) assay were used to measure dabigatran and rivaroxaban plasma levels, respectively.Measurements of all assays estimating anticoagulant activity across the 2 patient groups were similar, except for aPTT. Patients on dabigatran exhibited statistically significantly prolonged aPTT values (P < 0.001). In LTA, patients on dabigatran also showed decreased aggregation compared to those on rivaroxaban (P = 0.045). Regarding the TG test, there was no association between endogenous thrombin potential (ETP) and rivaroxaban plasma levels (P = 0.33) as opposed to dabigatran levels (P < 0.001), but significant correlations were observed between rivaroxaban plasma concentrations and kinetic parameters of TG assay (Tlag, P = 0.045; Tmax, P = 0.016; and Cmax, P = 0.003).Based on ROTEM and TG assays, the anticoagulant effects induced by the 2 drugs given in the specific dose regimens in real-world patients were comparable. Only platelet aggregation was found to be more affected by dabigatran as compared to rivaroxaban.
authors.affiliation: From the Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital(AET, EK, PD); Second Cardiology Department, "Attiko" Hospital(II, KK, IP, JL); Second Department of Critical Care Medicine, "Attiko" Hospital(PK, IT); Department of Microbiology (VK), School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; and Humanitas Clinical and Research Center (SB), Rozzano, Milan, Italy.
authors.forename: Argirios E
authors.initials: AE
authors.lastname: Tsantes
authors.forename: Elias
authors.initials: E
authors.lastname: Kyriakou
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Katogiannis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Papadakis
authors.forename: Panagiota
authors.initials: P
authors.lastname: Douramani
authors.forename: Petros
authors.initials: P
authors.lastname: Kopterides
authors.forename: Violetta
authors.initials: V
authors.lastname: Kapsimali
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
authors.forename: Iraklis
authors.initials: I
authors.lastname: Tsangaris
authors.forename: Stefanos
authors.initials: S
authors.lastname: Bonovas
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D001281:Atrial Fibrillation / Q000097:blood*; D001777:Blood Coagulation / Q000187:drug effects*; D000069604:Dabigatran / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D000069552:Rivaroxaban / Q000494:pharmacology*
chemical_list: D000925:Anticoagulants; D000069552:Rivaroxaban; D000069604:Dabigatran