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Reversión de rivaroxaban y dabigatrán por el concentrado del complejo de protrombina: un estudio cruzado
Elise S Eerenberg1, Pieter W Kamphuisen, Meertien K Sijpkens
1Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. e.s.eerenberg@amc.uva.nl
Circulation
|September 9, 2011
Resumen
El concentrado de complejo de protrombina (PCC) invierte efectivamente el rivaroxaban.
Área de la Ciencia:
- Farmacología Farmacología.
- Hematología Hematología.
- La medicina clínica es la medicina clínica.
Sus antecedentes:
- Rivaroxaban y dabigatrán son nuevos anticoagulantes orales utilizados para la prevención y el tratamiento de la tromboembolía.
- Una limitación crítica es la falta de un antídoto fácilmente disponible para las emergencias de sangrado.
- El concentrado de complejo de protrombina (PCC) se está investigando como un posible agente de reversión.
Objetivo del estudio:
- Evaluar la eficacia del PCC en la reversión de los efectos anticoagulantes del rivaroxabán y el dabigatrán.
- Evaluar el impacto de la PCC en parámetros específicos de la coagulación en voluntarios sanos.
Principales métodos:
- Un estudio aleatorizado, doble ciego, controlado con placebo que involucró a 12 voluntarios varones sanos.
- Los participantes recibieron rivaroxaban o dabigatrán, seguido de la administración de PCC o solución salina.
- Se realizaron pruebas de coagulación antes y después de la administración de fármacos y PCC/solución salina.
Principales resultados:
- PCC revirtió completa e inmediatamente la prolongación del tiempo de protrombina inducida por rivaroxaban y normalizó el potencial de trombina endógeno.
- La solución salina no tuvo ningún efecto en la actividad anticoagulante del rivaroxaban.
- La PCC no restauró las pruebas de coagulación afectadas por dabigatrán, incluidas aPTT, ECT y TT.
Conclusiones:
- La PCC invierte eficaz y rápidamente los efectos anticoagulantes del rivaroxaban en sujetos sanos.
- La PCC no demostró ningún efecto significativo en la reversión de la acción anticoagulante del dabigatrán en la dosis probada.
- Es posible que se necesiten más investigaciones para identificar agentes de reversión efectivos para el dabigatrán.
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