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The treatment effect of rivaroxaban on clot characteristics in patients who present acutely with first time deep vein thrombosis / Vanessa Evans, Matthew Lawrence, Janet Whitley, C. Johns, Suresh Pillai, Karl Hawkins, K. Power, K. Morris, Rhodri Williams, Adrian Evans
Clinical Hemorheology and Microcirculation, Pages: 1 - 13
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BACKGROUND: The acute vascular disease deep vein thrombosis (DVT) requires oral anticoagulants to prevent progression. Monitoring therapeutic efficacy of direct oral anticoagulants (DOAC), including rivaroxaban, is problematic as no reliable test is available. Advances in rheometry have led to the d...
|Published in:||Clinical Hemorheology and Microcirculation|
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BACKGROUND: The acute vascular disease deep vein thrombosis (DVT) requires oral anticoagulants to prevent progression. Monitoring therapeutic efficacy of direct oral anticoagulants (DOAC), including rivaroxaban, is problematic as no reliable test is available. Advances in rheometry have led to the development of a functional coagulation biomarker using Gel Point (GP) analysis which assesses clot structure formation. The biomarker measures incipient clot formation time (TGP) and quantifies fibrin clot structure in terms of fractal dimension (df).OBJECTIVE: This study aimed to investigate clot structure formation in first time DVT and the effect of rivaroxaban treatment.METHODS: This prospective observational cohort study measured the GP and standard laboratory markers at three sample points: pre-treatment and at 20 and 60 days following 15mg BD and 20mg OD rivaroxaban respectively. RESULTS: Forty DVT patients (mean age 64 years [SD±14.8]; 23 males, 17 female) were recruited. The results show that DVT vs non-DVT patients did not have a significantly different GP profile (df: 1.72±0.06 vs 1.70±0.06 and TGP: 267±68sec vs 262±73sec) with both within the defined healthy index. In addition, rivaroxaban therapy increased TGP to 392s (±135s) after 20 days, and subsequently increased to 395s (±194s) at 60 days but did not significantly increase df (from 1.69±0.05 to 1.71±0.06). CONCLUSIONS: The results indicate in this cohort of DVT patients there was no underlying hypercoagulable effect as determined by gel point analysis. Furthermore, the anticoagulant effect of rivaroxaban prolonged clotting, suggesting a protective effect against clot formation, without significantly reducing clot microstructural properties.
Rivaroxaban, coagulation inhibitors, venous thrombosis, clot structure, biomarkers
Swansea University Medical School