University of Hertfordshire

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Apixaban Enhances Endogenous Fibrinolysis in Patients with Atrial Fibrillation

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  • Nikolaos Spinthakis
  • Ying X. Gue
  • Mohamed Farag
  • Manivannan Srinivasan
  • David Wellsted
  • Gregory Y H Lip
  • Deepa RJ Arachchillage
  • Diana Gorog
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Original languageEnglish
JournalEP Europace
Journal publication date25 Jun 2019
DOIs
Publication statusPublished - 25 Jun 2019

Abstract

Background Approximately 20% of ischaemic stroke patients exhibit spontaneous arterial recanalization, attributable to endogenous fibrinolysis, which strongly relates to improved functional outcome. The impact of oral anticoagulants on endogenous fibrinolysis is unknown. Objective Our aim was to test the hypothesis that apixaban enhances endogenous fibrinolysis in non-valvular AF (NVAF). Methods In a prospective cross-sectional analysis, we compared endogenous fibrinolysis in NVAF patients (n=180) taking aspirin, warfarin or apixaban. In a prospective longitudinal study, patients were tested before and after apixaban (n=80). Endogenous fibrinolysis was assessed using the Global Thrombosis Test (GTT) and Thromboelastography (TEG). Results Endogenous fibrinolysis (measured by GTT lysis time [LT]) was shorter on apixaban compared to warfarin or aspirin (median 1850[IQR 1591-2300] vs. 2758[2014-3502] vs. 2135[1752-2463] sec, p<0.0001). Among TEG indices, a small but significant difference in clot lysis time (CLT) was observed (apixaban 60.0[45.0-61.0] vs. warfarin 61.0[57.0-62.0] vs. aspirin 61.0[59.0-61.0] min, p=0.036). Apixaban improved endogenous fibrinolysis measured using the GTT (LT pre-treatment 2204[1779-2738] vs. on-treatment 1882[1607-2374] sec, p=0.0003), but not by using TEG. Change in LT (DLT) with apixaban correlated with baseline LT (r=0.77, p<0.0001). There was weak correlation between DLT and DCLT in response to apixaban (r=0.28, p=0.02) and between on-apixaban LT and CLT (r=0.25, p=0.022). Conclusions Apixaban enhances endogenous fibrinolysis, with maximal effect in those with impaired fibrinolysis pre-treatment. Apixaban-treated patients exhibit more favourable fibrinolysis profiles than those taking warfarin or aspirin. Whether apixaban may confer 4 additional thrombotic risk reduction in NVAF patients with impaired fibrinolysis, compared to warfarin, merits further study.

ID: 16806819