Bleeding is the most feared and difficult to predict adverse event of anticoagulation. We sought to investigate whether calibrated automated thrombography (CAT) parameters are associated with minor bleeding (MB) in anticoagulated patients following venous thromboembolism (VTE). Enrolled were 132 patients on rivaroxaban, 145 on vitamin K antagonists (VKA) and 31 controls who stopped anticoagulation. Prior to the next dose of the anticoagulant, we measured CAT parameters, along with rivaroxaban concentration and INR. During a median follow-up of 10 months, we recorded minor and major bleedings. On rivaroxaban, 27 (20.5%) patients with MB had longer time to start thrombin generation, lower peak thrombin generation and lower endogenous thrombin potential compared with subjects without MB (all p < 0.001). All CAT parameters, except for peak thrombin generation (p = 0.049), were similar in VKA patients with (n = 25, 17.2%) vs. without MBs. By logistic regression, time to start thrombin generation (p = 0.007) and unprovoked VTE (p = 0.041) independently predicted MBs on rivaroxaban. Major bleedings were more frequent in patients with MBs (17.3% vs. 1.8%, p < 0.001). Abnormal CAT parameters characterize VTE patients prone to MBs on rivaroxaban, but not on VKA. Time to start thrombin generation measured about 24 h since the last rivaroxaban dose might help predict MBs.

译文

:出血是最令人恐惧和最难以预测的抗凝不良事件。我们试图调查在静脉血栓栓塞(VTE)后抗凝患者中,校准的自动血栓成像(CAT)参数是否与轻微出血(MB)相关。入选了132例使用rivaroxaban的患者,145例使用维生素K拮抗剂(VKA)的患者和31例停止抗凝治疗的对照组。在下一次服用抗凝剂之前,我们测量了CAT参数以及利伐沙班的浓度和INR。在10个月的中位随访期间,我们记录了轻度和重度出血。在利伐沙班上,与无MB的受试者相比,27名(20.5%)的MB患者开始凝血酶的时间更长,凝血酶的峰值生成量较低,内源性凝血酶的潜能较低(所有p <0.001)。 VKA患者(n = 25,17.2%)与未使用MBs的患者相比,除凝血酶峰值峰值(p = 0.049)外,所有CAT参数均相似。通过逻辑回归,开始凝血酶生成的时间(p = 0.007)和无缘无故的VTE(p = 0.041)独立预测了利伐沙班上的MB。 MBs患者的大出血发生率更高(17.3%vs. 1.8%,p <0.001)。 CAT参数异常是在利伐沙班上VBE患者倾向于MB的特征,而在VKA上则不然。从最后一次利伐沙班剂量起大约24小时开始测量凝血酶生成的时间,可能有助于预测MB。

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