Evaluation of the antithrombotic abilities of non-vitamin K antagonist oral anticoagulants using the Total Thrombus-formation Analysis System®

Abstract

The Total Thrombus-formation Analysis System (T-TAS) is a novel automated microchip flow-chamber system for the quantitative evaluation of thrombus formation under blood flow conditions. T-TAS uses two types of microchip to evaluate thrombus formation: the AR-chip quantifies white thrombus formation and the PL-chip quantifies platelet thrombus formation. We assessed the antithrombotic abilities of various non-vitamin K antagonist oral anticoagulants (NOACs) using T-TAS. One hundred and three consecutive patients who were hospitalized with cardiovascular diseases were enrolled. We divided the patients into 2 groups; a control group that did not receive an anticoagulant (non-AC group) and an anticoagulant group (AC group). The AC group was further divided into warfarin, dabigatran, rivaroxaban and apixaban groups. We performed common coagulation tests and evaluated the area under the flow pressure curve (AR-AUC and PL-AUC) to quantify antithrombotic ability using T-TAS at the trough. There were no significant differences in patient characteristics between the non-AC and AC groups. Only 55.1 % of patients in the AC group achieved the target blood pressure (BP) of less than 130/80 mmHg. Compared with the non-AC group, AR-AUC was significantly decreased in the AC, warfarin, dabigatran and apixaban groups. Only the rivaroxaban group did not show a significant decrease in AR-AUC. NOACs showed a significant decrease in PL-AUC compared with the non-AC group. In conclusion, T-TAS was a useful tool for evaluating anticoagulation activity. NOACs was significantly effective as an antiplatelet agent. BP control should be a higher priority than the selection of an anticoagulant drug, especially NOACs.

Evaluation of the Antithrombotic Effects of Rivaroxaban and Apixaban Using the Total Thrombus-Formation Analysis System®: In Vitro and Ex Vivo Studies

“…The T-TAS ® was initially developed to monitor the efficacy of anticoagulants [10]. Using the T-TAS ® , we recently demonstrated that blood samples from patients who had taken NOACs showed less ex vivo fibrin-rich thrombus formation under a constant low rate flow condition [11]. This study supported the usefulness of the T-TAS ® for monitoring the anticoagulant effects of NOACs in clinical practice.…”

“…Although the rivaroxaban group had less athero-thrombogenicity at the trough in the AR-chip analysis, this group had a similar capacity for platelet thrombus formation at any time point in PL-chip analysis, as compared to the apixaban group. We previously reported that blood samples from patients who were taking NOACs, including dabigatran, rivaroxaban and apixaban, had significantly lower PL-AUC levels at trough than control blood from patients who were not receiving any anticoagulant [11]. Taken together, PL analysis by T-TAS ® for patients was influenced by NOACs administration, but it was not suitable for the quantitative assessment of platelet function of NOACs.…”

“…The T-TAS ® is an automated microchip-based flow chamber system that analyzes thrombus formation using two types of single-use microchips, as previously described in detail [11]. Briefly, the capillary of the platelet chip (PL-chip) is coated with type I collagen; platelets from blood samples adhere and aggregate inside the microchip under constant flow conditions.…”

Effects of glycemic control and hypoglycemia on Thrombus formation assessed using automated microchip flow chamber system: an exploratory observational study

“…Earlier studies investigated the effects of anti-platelet or anti-coagulant drugs on T-TAS measurements [41, 42]. One study that evaluated the effects of warfarin or direct-acting oral coagulants (DOACs) with T-TAS [43] showed a decrease in AR-AUC30, similar to the results of STUDY 1.…”

The Use of Total Thrombus Formation Analysis System as a Tool to Assess Platelet Function in Bleeding and Thrombosis Risk—A Systematic Review

“…The topic of anticoagulants was dealt with by Idemoto et al [10] in which scientists assessed the effect of antithrombotic abilities of various novel oral anticoagulants (NOACs) using T-TAS as a useful tool for monitoring antithrombotic effects using both types of chips, and performed common coagulation tests. Authors evaluated the area under the flow pressure curve to quantify antithrombotic ability using T-TAS.…”