Anticoagulation index of dabigatran etexilate anticoagulation therapy for patients with non-valvular atrial fibrillation

Abstract

Objective To evaluate the suitable indexes of dabigatran etexilate anticoagulation intensity in patients with non-valvular atrial fibrillation(NVAF). Methods Thirty-four NVAF patients taking dabigatran etexilate(110 mg, bid)were enrolled [age, 52~81(67.8±8.0)years; male, 67.6%]from Feb.2014 to May 2015.Clinical symptoms and signs were recorded and coagulation indexes[prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), international nomalized ratio(INR), prothrombin activity(PTA), fibrous protein(FIB), antithrombin Ⅲ(AT3)activity, D-dimer]were measured before taking dabigatran etexilate and after 1, 4 weeks and 3 months. Results ①There were no significant changes in INR, FIB, PTA, AT3 activity and D-dimer between pre and post treatment(P>0.05). ②Before and after treatment 1 weeks[PT(10.9±0.7) s vs.(11.3±0.6) s, P=0.030; APTT(31.1±2.5) s vs.(39.3±3.0) s, P=0.024; TT(13.7±0.7) s vs.(134.6±8.2) s, P=0.001], 4 weeks[PT(10.9±0.7) s vs.(11.6±0.6) s, P=0.023; APTT(31.1±2.5) s vs.(44.9±4.5) s, P=0.002; TT(13.7±0.7) s vs.(152.3±9.1) s, P=0.001], 3 months[PT(10.9±0.7) s vs.(12.3±0.6) s, P=0.012; APTT(31.1±2.5) s vs.(52.4±5.0) s, P=0.001; TT(13.7±0.7) s vs.(161.9±7.8) s, P=0.001], the differences were statistically significant.③No events of the embolism or big bleeding occurred in the patients after taking the drugs, and there were slight bleeding in 5 cases with significantly extended PT, APTT, TT, and more than 2 times of APTT compared with the normal reference value.④PT, APTT, TT growth rate showed that the area of APTT growth rate under the curve was the largest(ROC area: PT growth rate was 0.741, APTT 0.914, TT 0.891)and the best cut-off point of APTT growth rate was 101.39%. Conclusion ①The level of APTT may be a reliable index for monitoring anticoagulation intensity during NVAF patients taking dabigatran etexilate.②The level of APTT should be controlled within 2 times of the normal value. Key words: Dabigatran etexilate; Non-valvular atrial fibrillation; Anticoagulant therapy