期刊
JOURNAL OF HEART AND LUNG TRANSPLANTATION
卷 30, 期 2, 页码 218-226出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.healun.2010.08.027
关键词
anti-coagulants; drugs; cardiac output; pharmacokinetics; thrombosis
资金
- Bayer Schering Pharma AG
- Johnson & Johnson Pharmaceutical Research & Development, LLC
- National Institutes of Health (NIH)
- Otsuka
- Sigma Tau
- Merck
- Scios
- National Heart, Lung and Blood Institute
BACKGROUND: Heart failure (HF) is associated with a hypercoagulable state that predisposes to thromboembolism and anti-coagulation may improve clinical outcomes. The oral, direct Factor Xa inhibitor, rivaroxaban, has not been studied in patients with HF. We hypothesized that rivaroxaban would also reduce biomarkers of hypercoagulability in patients with HF. METHODS: This study consisted of two cohorts: Cohort 1, open-label, actively controlled with enoxaparin 40 mg once daily, included 8 patients with acute decompensated HF; Cohort 2, double-blind and placebo-controlled, included 18 patients with stable, severe New York Heart Association Class III/IV HF. RESULTS: The pharmacokinetics (PK) and pharmacodynamics (PD) of rivaroxaban were similar across both cohorts. Biomarker assessments were performed in Cohort 2; prothrombin fragment 1.2 (F1.2) mean concentration decreased by 2.7 ng/ml over 7 days with rivaroxaban, and increased by 11.6 ng/ml with placebo, an absolute difference of 14.3 ng/ml (p = 0.0009). A non-significant reduction in rate of increase of D-dimer (DD) and thrombin-anti-thrombin complex (TAT) levels with rivaroxaban was observed over 7 days (p = 0.31 and p = 0.77, respectively). CONCLUSION: Rivaroxaban has similar PK/PD in patients with either acute or chronic HF. In vivo, hypercoagulability biomarkers appear to increase over time. Rivaroxaban reversed this trend for F1.2, and may reduce the rate of increase of DD and TAT in patients with stable, severe HF. J Heart Lung Transplant 2011;30:218-26 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.
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