A direct oral anticoagulant, edoxaban, is as effective as vitamin K antagonists for the treatment of venous thromboembolism (VTE). However, the mechanism underlying the treatment effect on VTE remains to be determined. The aims of this study were to evaluate the effect of edoxaban on tissue plasminogen activator (t-PA)-induced clot lysis in human plasma and to determine the roles of plasmin and thrombin-activatable fibrinolysis inhibitor (TAFI) in the profibrinolytic effect by edoxaban. Pooled human normal plasma or TAFI-deficient plasma (containing 180 ng/mL t-PA and 0.1 nM thrombomodulin) was mixed with edoxaban or an activated TAFI inhibitor, potato tuber carboxypeptidase inhibitor (PCI). Clot was induced by adding tissue factor and phospholipids. Clot lysis time and plasma plasmin-α2 antiplasmin complex (PAP) concentration were determined. Clot structure was imaged with a scanning electron microscope. In normal plasma, edoxaban at clinically relevant concentrations (75, 150, and 300 ng/mL) and PCI significantly shortened clot lysis time. PCI increased PAP concentration and a correlation between PAP concentration and percent of clot lysis was observed. Edoxaban also dose-dependently elevated PAP concentration. In TAFI-deficient plasma, the effects of edoxaban and PCI on clot lysis and PAP concentration were markedly diminished as compared with normal plasma. Fibrin fibers were thinner in clots formed in the presence of edoxaban. In conclusion, edoxaban at clinically relevant concentrations accelerates t-PA-induced fibrinolysis via increasing plasmin generation in human plasma. The effects of edoxaban is mainly dependent on TAFI. The profibrinolytic effect of edoxaban might contribute to the efficacy for the treatment of VTE.

译文

:直接口服抗凝剂edoxaban与维生素K拮抗剂在治疗静脉血栓栓塞(VTE)方面一样有效。但是,对VTE的治疗作用的潜在机制尚待确定。这项研究的目的是评估依多沙班对人血浆中纤溶酶原激活物(t-PA)诱导的血块溶解的影响,并确定纤溶酶和凝血酶可激活的纤溶抑制剂(TAFI)在依多沙班促纤溶作用中的作用。将合并的人类正常血浆或TAFI缺陷血浆(包含180ng / mL t-PA和0.1nM血栓调节素)与edoxaban或活化的TAFI抑制剂马铃薯块茎羧肽酶抑制剂(PCI)混合。通过添加组织因子和磷脂诱导凝集。测定凝块溶解时间和血浆纤溶酶-α2抗纤溶酶复合物(PAP)浓度。用扫描电子显微镜对凝块结构成像。在正常血浆中,临床相关浓度(75、150和300ng / mL)的edoxaban和PCI显着缩短了血凝块溶解时间。 PCI增加了PAP浓度,并观察到PAP浓度与凝块溶解百分比之间存在相关性。依多沙班也剂量依赖性地升高PAP浓度。在TAFI缺乏的血浆中,与正常血浆相比,edoxaban和PCI对血块溶解和PAP浓度的影响明显减弱。血纤蛋白纤维在edoxaban存在下形成的凝块中较细。总之,在临床上相关浓度的依多沙班通过增加人血浆中纤溶酶的产生来加速t-PA诱导的纤维蛋白溶解。 edoxaban的作用主要取决于TAFI。依多沙班的纤溶作用可能有助于治疗VTE。

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