Reversal of Apixaban Induced Alterations in Hemostasis by Different Coagulation Factor Concentrates: Significance of Studies In Vitro with Circulating Human Blood

摘要: Apixaban is a new oral anticoagulant with specific inhibitory action on FXa. No information available the reversal of antihemostatic apixaban in experimental or clinical settings. We have evaluated effectiveness different factor concentrates at reversing modifications hemostatic mechanisms induced by moderately elevated concentrations (200 ng/ml) added vitro to blood from healthy donors (n = 10). Effects thrombin generation (TG) and thromboelastometry (TEM) parameters were assessed. Modifications platelet adhesive, aggregating procoagulant activities studies circulating through damaged vascular surfaces, shear rate 600 s(-1). The potential prothrombin complex (PCCs; 50 IU/kg), activated (aPCCs; 75 recombinant VII (rFVIIa; 270 μg/kg), actions apixaban, investigated. interfered TG kinetics. Delayed lag phase, prolonged time peak reduced values, improved concentrates, though patterns diversely affected depending activating reagents. significantly clotting times (CTs) TEM studies. Prolongations CTs corrected variable efficacies (rFVIIa≥aPCC>PCC). fibrin interactions surfaces perfusion (p<0.05 p<0.01, respectively). Impairments formation normalized concentrates. Only rFVIIa restored levels deposition. Alterations hemostasis variably compensated However, effects these not homogeneous all tests, PCCs showing more efficacy TG, being effective Our results indicate that rFVIIa, aPCCs restore components previously altered apixaban.