PMID- 37209152
OWN - NLM
STAT- MEDLINE
DCOM- 20231023
LR  - 20240412
IS  - 1432-1912 (Electronic)
IS  - 0028-1298 (Linking)
VI  - 396
IP  - 11
DP  - 2023 Nov
TI  - In vitro evaluation of anticoagulant therapy management when urgent percutaneous 
      coronary intervention is required in rivaroxaban-treated patients.
PG  - 3221-3232
LID - 10.1007/s00210-023-02533-2 [doi]
AB  - We investigated in vitro the management of intraprocedural anticoagulation in 
      patients requiring immediate percutaneous coronary intervention (PCI) while using 
      regular direct oral anticoagulants (DOACs). Twenty-five patients taking 20 mg of 
      rivaroxaban once daily comprised the study group, while five healthy volunteers 
      included the control group. In the study group, a beginning (24 h after the last 
      rivaroxaban dose) examination was performed. Then, the effects of basal and four 
      different anticoagulant doses (50 IU/kg unfractionated heparin (UFH), 100 IU/kg 
      UFH, 0.5 mg/kg enoxaparin, and 1 mg/kg enoxaparin) on coagulation parameters were 
      investigated at the 4th and 12th h following rivaroxaban intake. The effects of 
      four different anticoagulant doses were evaluated in the control group. The 
      anticoagulant activity was assessed mainly by anti-factor Xa (anti-Xa) levels. 
      Beginning anti-Xa levels were significantly higher in the study group than in the 
      control group (0.69 +/- 0.77 IU/mL vs. 0.20 +/- 0.14 IU/mL; p < 0.05). The study 
      group's 4th and 12th-h anti-Xa levels were significantly higher than the 
      beginning level (1.96 +/- 1.35 IU/mL vs. 0.69 +/- 0.77 IU/mL; p < 0.001 and 0.94 +/- 
      1.21 IU/mL vs. 0.69 +/- 0.77 IU/mL; p < 0.05, respectively). Anti-Xa levels 
      increased significantly in the study group with the addition of UFH and 
      enoxaparin doses at the 4th and 12th h than the beginning (p < 0.001 at all 
      doses). The safest anti-Xa level (from 0.94 +/- 1.21 to 2.00 +/- 1.02 IU/mL) was 
      achieved 12 h after rivaroxaban with 0.5 mg/kg enoxaparin. Anticoagulant activity 
      was sufficient for urgent PCI at the 4th h after rivaroxaban treatment, and 
      additional anticoagulant administration may not be required at this time. Twelve 
      hours after taking rivaroxaban, administering 0.5 mg/kg of enoxaparin may provide 
      adequate and safe anticoagulant activity for immediate PCI. This experimental 
      study result should confirm with clinical trials (NCT05541757).
CI  - (c) 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
      part of Springer Nature.
FAU - Melek, Mehmet
AU  - Melek M
AD  - Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey.
FAU - Ari, Hasan
AU  - Ari H
AD  - Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey. 
      hasanari03@yahoo.com.
FAU - Ari, Selma
AU  - Ari S
AD  - Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey.
FAU - Cilgin, Mehmet Can
AU  - Cilgin MC
AD  - Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey.
FAU - Yarar, Mucahit
AU  - Yarar M
AD  - Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey.
FAU - Huysal, Kagan
AU  - Huysal K
AD  - Department of Biochemistry, Bursa Postgraduate Hospital, Bursa, Turkey.
FAU - Agca, Fahriye Vatansever
AU  - Agca FV
AD  - Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey.
FAU - Bozat, Tahsin
AU  - Bozat T
AD  - Department of Cardiology, Bursa Postgraduate Hospital, Bursa, Turkey.
LA  - eng
SI  - ClinicalTrials.gov/NCT05541757
PT  - Journal Article
DEP - 20230520
PL  - Germany
TA  - Naunyn Schmiedebergs Arch Pharmacol
JT  - Naunyn-Schmiedeberg's archives of pharmacology
JID - 0326264
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Humans
MH  - *Enoxaparin/pharmacology/therapeutic use
MH  - Heparin/therapeutic use/pharmacology
MH  - Rivaroxaban/therapeutic use
MH  - *Percutaneous Coronary Intervention
MH  - Anticoagulants
OTO - NOTNLM
OT  - Enoxaparin
OT  - Percutaneous coronary intervention
OT  - Rivaroxaban
OT  - Unfractionated heparin
EDAT- 2023/05/20 19:13
MHDA- 2023/10/23 00:42
CRDT- 2023/05/20 14:51
PHST- 2022/11/28 00:00 [received]
PHST- 2023/05/15 00:00 [accepted]
PHST- 2023/10/23 00:42 [medline]
PHST- 2023/05/20 19:13 [pubmed]
PHST- 2023/05/20 14:51 [entrez]
AID - 10.1007/s00210-023-02533-2 [pii]
AID - 10.1007/s00210-023-02533-2 [doi]
PST - ppublish
SO  - Naunyn Schmiedebergs Arch Pharmacol. 2023 Nov;396(11):3221-3232. doi: 
      10.1007/s00210-023-02533-2. Epub 2023 May 20.