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dc.contributor.authorSpinthakis, Nikolaos
dc.contributor.authorGue, Ying X.
dc.contributor.authorFarag, Mohamed
dc.contributor.authorSrinivasan, Manivannan
dc.contributor.authorWellsted, David
dc.contributor.authorLip, Gregory Y H
dc.contributor.authorArachchillage, Deepa RJ
dc.contributor.authorGorog, Diana
dc.date.accessioned2019-08-01T16:21:47Z
dc.date.available2019-08-01T16:21:47Z
dc.date.issued2019-09-01
dc.identifier.citationSpinthakis , N , Gue , Y X , Farag , M , Srinivasan , M , Wellsted , D , Lip , G Y H , Arachchillage , D RJ & Gorog , D 2019 , ' Apixaban Enhances Endogenous Fibrinolysis in Patients with Atrial Fibrillation ' , EP Europace , vol. 21 , no. 9 , pp. 1297-1306 . https://doi.org/10.1093/europace/euz176
dc.identifier.issn1099-5129
dc.identifier.otherPURE: 16806819
dc.identifier.otherPURE UUID: bcad3dfc-2293-4ade-8481-303a08d2bd05
dc.identifier.otherScopus: 85071048717
dc.identifier.otherPubMed: 31505618
dc.identifier.urihttp://hdl.handle.net/2299/21537
dc.description© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
dc.description.abstractAIMS: 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. Our aim was to test the hypothesis that apixaban enhances endogenous fibrinolysis in non-valvular atrial fibrillation (NVAF). METHODS AND RESULTS: 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). Endogenous fibrinolysis [measured by GTT lysis time (LT)] was shorter on apixaban compared with warfarin or aspirin [median 1850 (IQR 1591-2300) vs. 2758 (2014-3502) vs. 2135 (1752-2463) s, 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) s, P = 0.0003], but not by using TEG. Change in LT (ΔLT) with apixaban correlated with baseline LT (r = 0.77, P < 0.0001). There was weak correlation between ΔLT and ΔCLT in response to apixaban (r = 0.28, P = 0.02) and between on-apixaban LT and CLT (r = 0.25, P = 0.022). CONCLUSION: 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 additional thrombotic risk reduction in NVAF patients with impaired fibrinolysis, compared to warfarin, merits further study.en
dc.format.extent10
dc.language.isoeng
dc.relation.ispartofEP Europace
dc.subjectApixaban
dc.subjectAtrial fibrillation
dc.subjectEndogenous fibrinolysis
dc.subjectNon-vitamin K antagonist oral anticoagulant
dc.subjectThrombosis
dc.subjectCardiology and Cardiovascular Medicine
dc.subjectPhysiology (medical)
dc.titleApixaban Enhances Endogenous Fibrinolysis in Patients with Atrial Fibrillationen
dc.contributor.institutionSchool of Life and Medical Sciences
dc.contributor.institutionDepartment of Clinical and Pharmaceutical Sciences
dc.contributor.institutionCentre for Health Services and Clinical Research
dc.contributor.institutionBasic and Clinical Science Unit
dc.contributor.institutionHealth Research Methods Unit
dc.contributor.institutionCentre for Research in Psychology and Sport Sciences
dc.contributor.institutionDepartment of Psychology and Sports Sciences
dc.contributor.institutionBehaviour Change in Health and Business
dc.contributor.institutionPsychology
dc.description.statusPeer reviewed
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85071048717&partnerID=8YFLogxK
rioxxterms.versionAM
rioxxterms.versionofrecordhttps://doi.org/10.1093/europace/euz176
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue


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