Study On The Effect Of New Oral Anticoagulant On Platelet Function And Coagulation Function In Patients With Atrial Fibrillation

Objective: By studying the changes of three indicators of platelet activation,platelet aggregation rate and coagulation function in patients with non-valvular atrial fibrillation after taking dabigatran and rivaroxaban,the effects of dabigatran and rivaroxaban on platelet function and the differences in anticoagulant strength in patients with atrial fibrillation were preliminarily discussed.Materials and Methods: A total of 36 patients with nonvalvular atrial fibrillation who visited the department of cardiology of our hospital from March 2017 to November 2018 were continuously collected.The subjects were randomly divided into two groups by simple random grouping: the dabigatran ester treatment group(N=18 110 mg Bid Po);Rivaroxaban treatment group(N=18 15 mg or 20 mg Qd Po).The patient's basic information(age,gender,height,weight),previous medical history,drug application,routine blood tests,liver and kidney functions were recorded in detail.Platelet activation and platelet aggregation rate were measured before and after 7 days of treatment.The platelet activation function related indicators CD62 P and PAC-1 were determined by flow cytometry.Platelet aggregation agents arachidonic acid(AA),adenosine diphosphate(ADP),adrenaline(EPI)and collagen(Col)were used to detect maximum platelet aggregation rate(MAR).At the same time,Anticoagulant index such as D-dimer,prothrombin time(PT),activated partial 4 thromboplastin time(APTT),international normalized value(INR)and thrombin time measurement(TT)were measured before and after 7 days of treatment.SPSS18.0 statistical software was used for statistical analysis,and P<0.05 was statistically significant.Results: 1.The expression levels of CD62 P and PAC-1 were significantly decreased in patients with dabigatinide group before and 7 days after treatment(P<0.05),there were no significant changes in AA,ADP,EPI and COL(P>0.05).D-dimer value showed no significant change(P>0.05),and PT,INR,FIB,APTT and TT values were prolonged(P<0.01),Among the coagulation indexes,TT value had the largest change,followed by APTT value.2.The expression levels of CD62 P and PAC-1 were significantly decreased in the rivaroxaban group before and 7 days after treatment(P<0.05).There were no significant changes in the maximum platelet aggregation rate in AA,ADP,EPI and COL(P>0.05).D-dimer,FIB and TT values showed no significant change(P > 0.05),and PT,INR and APTT values were prolonged(P<0.01).Among the coagulation indexes,PT value had the largest change,followed by APTT value.3.Compared with rivaroxaban and rivaroxaban,the changes of platelet activation,platelet aggregation rate and coagulation function were compared.The changes of platelet activation index CD62 P and PAC-1 before and after medication were not significantly different between the two groups(P>0.05).Platelet maximum aggregation rate of AA,ADP,APTT,COL variation before and after medication has no obvious difference between the two groups(P>0.05).The changes of D-dimer,PT and INR values did not change significantly between the two groups(P>0.05),and the changes of FIB,APTT and TT values in dabigatran etexilate group were significantly higher than those in rivaroxaban group(P<0.05 or P<0.01).Conclusion: 1.Dabigatran and rivaroxaban can reduce the expression of CD62 P and PAC-1 on platelet surface in patients with non-valvular atrial fibrillation,suggesting that the two new oral anticoagulants may have antiplatelet effects while anticoagulation.2.The results of this study suggest that dabigatran etexilate and rivaroxaban have no effect on platelet aggregation rate in patients with atrial fibrillation,but given the small sample size,further large-scale clinical trials are needed.3.The TT index in the dabigatran etexilate group changed most significantly before and after taking the drug.The PT index in the rivaroxaban group changed most significantly before and after taking the drug.