Peri-procedural use of rivaroxaban in elective percutaneous coronary intervention to treat stable coronary artery disease. The X-PLORER trial
P Vranckx, F W G Leebeek, J G P Tijssen, J Koolen, F Stammen, J-P R Herman, R J de Winter, A W J van T Hof, B Backx, W Lindeboom, S-Y Kim, B Kirsch, M van Eickels, F Misselwitz, F W A Verheugt, P Vranckx, F W G Leebeek, J G P Tijssen, J Koolen, F Stammen, J-P R Herman, R J de Winter, A W J van T Hof, B Backx, W Lindeboom, S-Y Kim, B Kirsch, M van Eickels, F Misselwitz, F W A Verheugt
Abstract
Patients on rivaroxaban requiring percutaneous coronary intervention (PCI) represent a clinical conundrum. We aimed to investigate whether rivaroxaban, with or without an additional bolus of unfractionated heparin (UFH), effectively inhibits coagulation activation during PCI. Stable patients (n=108) undergoing elective PCI and on stable dual antiplatelet therapy were randomised (2:2:2:1) to a short treatment course of rivaroxaban 10 mg (n=30), rivaroxaban 20 mg (n=32), rivaroxaban 10 mg plus UFH (n=30) or standard peri-procedural UFH (n=16). Blood samples for markers of thrombin generation and coagulation activation were drawn prior to and at 0, 0.5, 2, 6-8 and 48 hours (h) after start of PCI. In patients treated with rivaroxaban (10 or 20 mg) and patients treated with rivaroxaban plus heparin, the levels of prothrombin fragment 1 + 2 at 2 h post-PCI were 0.16 [0.1] nmol/l (median) [interquartile range, IQR] and 0.17 [0.2] nmol/l, respectively. Thrombin-antithrombin complex values at 2 h post-PCI were 3.90 [6.8]µg/l and 3.90 [10.1] µg/l, respectively, remaining below the upper reference limit (URL) after PCI and stenting. This was comparable to the control group of UFH treatment alone. However, median values for thrombin-antithrombin complex passed above the URL with increasing tendency, starting at 2 h post-PCI in the UFH-alone arm but not in rivaroxaban-treated patients. In this exploratory trial, rivaroxaban effectively suppressed coagulation activation after elective PCI and stenting.
Keywords: Anticoagulation; coronary artery disease; rivaroxaban; thrombosis.
Conflict of interest statement
Conflicts of interest Pascal Vranckx has received research grants from Bayer Health-Care, Boehringer Ingelheim and Daiichi Sankyo; honoraria for advisory board and lectures from BMS-Pfizer. Freek W. A. Verheugt has received honoraria for consulting and speaking from Bayer HealthCare, Boehringer Ingelheim, BMS/Pfizer and Daiichi Sankyo. So-Young Kim, Bodo Kirsch, Martin van Eickels and Frank Misselwitz report being employees of Bayer HealthCare. No other potential conflict of interest relevant to this article was reported.
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Source: PubMed