Anticoagulation Index Of Dabigatran Etexilate Anticoagulation Therapy For Patients With Non-valvular Atrial Fibrillation

Objective:This study aims to observe variations in coagulation index for NVAF patients after taking dabigatran etexilate. In the meanwhile, it is to explore the suitable indexes to monitor anticoagulation intensity of dabigatran etexilate.Methods:34 NVAF subjects(male, 23 and female, 11), which included outpatients and inpatients from Feb. 2014 to May. 2015 [age, 52~81(67.8±8.0) years], were given dabigatran etexilate(110mg, bid) to be taken orally twice a day. After taking dabigatran etexilate orally, the following aspects concerning with the details of the study were examined. In the first place, clinical symptoms and signs of patients were observed.Apart from this, those elements were monitored for patients before taking dabigatran etexilate, and taking it for one week, four weeks and three months, which involved in 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. Use indicators in different periods draw the receiver operating curve(ROC) analysis. Comparison of the predictive ability of each coagulation index on the risk of bleeding depends to the area under the curve of ROC curve.Results:Outcomes from this study were obtained, including the following aspects. There was no significance of INR, FIB, PTA, AT3 activity and D-dimer between pre and post treatment(P>0.05); PT, APTT and TT levels were extended at 1 weeks, 4 weeks and 3months after treatment(P<0.05); There was no occurrence of embolism or big bleeding in patients after taking dabigatran etexilate. Slight bleeding in five cases took place, 2 cases of nasal bleeding, 1 cases of subcutaneous hemorrhage, 2 cases of hematochezia, with significantly extended PT, APTT, TT, and more than 2 times of APTT compared with the normal reference value. Bleeding symptoms were relieved after reduction; Curve analysis for PT, APTT, TT using receiver operating characteristic(ROC) were conducted,indicating that area of PT growth rate under ROC curve was 0.741; APTT 0.914 and TT0.891. In addition, the area of APTT growth rate under the curve was the largest and the best cut-off point of APTT growth rate was 101.39%.Conclusion:The level of APTT may be a reliable index which monitors anticoagulation intensity during NVAF patients taking dabigatran etexilate; The level of APTT should be controlled within 2 times of the normal value.