Introduction: Patients with NVAF and CHA2DS2-VASc score ≥2 must undergo anticoagulant treatment for the prevention of ischemic cerebrovascular incidents and periferal thromboembolisms.
Purpose: The comparative laboratory evaluation of coagulant and fibrinolytic action of the available DOACs (Dabigatran Etexilate, Rivaroxaban, Apixaban), as measured with Thromboelastometry (ROTEM), as well as the correlation of the parameters of the Thromboelastometry with the peak levels of those drugs in the plasma.
Methods: 80 patients with NVAF under anticoagulant treatment from the Attikon General Hospital of Athens, as well as 20 healthy blood donor volunteers. In all participants blood tests were carried out, and ROTEM at the peak levels of the drugs. Stata software was used for the statistical analysis, with the level of statistical significance at p<0,05.
Results: The pairs comparison of the patients' groups in relation to the demographic parameters of age and gender, does not reveal statistically significant differences (p>0,05). The pairs comparison of the patients' groups in relation to the risk factors (diabetes mellitus, dyslipidaemia, smoking, hypertention, vascular disease) and CHA2DS2-VASc score, does not reveal statistically significant differences (p>0,05), except the one conserning the smoking habits in the Sintrom group(5%) and the Rivaroxaban group (35%) (p=0,02) the one conserning hypertention in the Sintrom group (45%) and the Apixaban group (85%) (p=0,008). The pairs comparison of the patients' groups in relation to the parameters of the CBC, does not reveal statistically significant differences (p>0,05). Moreover, the pairs comparison of the patients' groups in relation to the basic biochemical parameters, does not reveal statistically significant differences (p>0,05). The parameters of ROTEM does not reveal statistically significant differences amongst NVAF under DOACs treatment, except a prolonged CT, among patients taking Dabigatran and those taking Apixaban p=0,014. The CT and the CFT are statistically significantly prolonged in all patient groups in comparison with the control group p<0,001. In all DOAC-groups the a-angle is larger in comparison with the control group 0,001
Conclusions: The ROTEM parameters do not correlate with the peak plasma levels of the 3 DOACs, therefore ROTEM is of no use in the monitoring of those drugs. Patients under DOACs treatment appear to form clots of the same size as of the patients under Sintrom treatment but of a rather reduced dynamics.
