Effects of Rivaroxaban on Platelet Aggregation

Abstract

Rivaroxaban is a direct oral anti-factor Xa anticoagulant. It has recently been suggested that rivaroxaban may affect platelet function in vitro; however, little is known about the clinical impact of this likely antiplatelet effect and whether this probable phenomenon is dose-dependent. Our aim was to determine whether rivaroxaban at 4 different doses inhibits direct platelet aggregation. We included adult patients of both sexes and who were allocated to one of the following groups depending on the prescribed daily dose of rivaroxaban: 5, 10, 15, and 20 mg. In 80 patients (20 patients/group), the percentage of platelet aggregation was determined by means of platelet aggregometry tests before and after rivaroxaban use. Basal samples were obtained before starting rivaroxaban and 1 month after treatment, both 2 and 24 hours after the last dose of the drug (12 hours after in the case of rivaroxaban 5 mg). We used 5 platelet agonists: adenosine diphosphate, epinephrine, arachidonic acid, collagen, and thrombin. There were no significant changes in the percentage of platelet aggregation before and after rivaroxaban use independently of the dose administered and the agonist used. Our results have clearly shown that rivaroxaban, even at a high dose, does not directly affect platelet aggregation.

Application of Activators Ecarin and Factor Xa in Thrombelastography for Measurement of Anticoagulant Effect of Direct Oral Anticoagulants Using TEG 5000

“…While the Plate-letMapping assay by TEG is not the gold standard for platelet function test, the findings are still compatible with prior studies on DOAC effects on platelets. 17,18 This study was limited due to the low number of participants. It was furthermore limited by few measurement time points: only four time points in phase I and three time points in phase II studies.…”

“…While the PlateletMapping assay by TEG is not the gold standard for platelet function test, the findings are still compatible with prior studies on DOAC effects on platelets. 17 18…”

Spontaneous epidural hematoma induced by rivaroxaban: A case report and review of the literature

“…[ 35 ] However, a study found that even at high doses, rivaroxaban does not directly affect platelet aggregation. [ 11 ] In a recent study, a 72-year-old woman with paroxysmal atrial fibrillation developed a spontaneous spinal epidural hematoma (SSEH) caused by rivaroxaban. The patient’s use of rivaroxaban may be a risk factor for the development of SSEH and a contributor to the patient’s poor prognosis.…”

Application Of Thrombelastography (TEG) For Evaluation Of Hypercoagulable State In Perioperative Period Of Primary/Revision Total Hip Arthroplasty (THA)

“…Rivaroxaban, an oral direct factor Xa inhibitor, been proven safe and e cacious. In 2020, a study of Hernandez-Juarez et al [27] showed that even a high dose of rivaroxaban did not affect platelet aggregation. This may be the reason that the proportion of platelet hypercoagulation and mixed hypercoagulation increased signi cantly with the extension of postoperative time.…”