P2642Effect of rivaroxaban on coagulation and inflammation biomarkers: results from an X-VeRT substudy

Abstract

Background: The effects of the non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) such as rivaroxaban on coagulation and inflammatory biomarkers in patients undergoing cardioversion are unknown. Here, we investigated the effects of rixaroxaban and VKA in patients enrolled into the X-VeRT trial. Purpose: Predefined biomarkers of coagulation and inflammation were evaluated in patients without adequate anticoagulation at randomization in X-VeRT. Methods: Plasma levels of prothrombin fragment 1 and 2 (F1,2), D-dimer, thrombin anti-thrombin complex (TAT), high sensitivity C reactive protein (hs-CRP) and high sensitivity interleukin 6 (hs-IL-6) were determined in a central lab at randomization (n=958) and at the end of treatment (42 days after cardioversion, n=918). The changes in biomarker concentrations during treatment with rivaroxaban or VKA were analysed and related to outcomes. Results: Both rivaroxaban and VKA were associated with decreased concentrations of D-dimer (p<0.001, p<0.001; respectively), TAT (p<0.001, p<0.001; respectively), hs-CRP (p=0.003, p=0.001; respectively) and hs-IL-6 (p=0.001, p=0.010; respectively); F1,2 concentrations were reduced in patients on VKA, but unchanged on rivaroxaban (p<0.001, p=0.536; respectively) (Table). There were no significant differences of changes between rivaroxaban and VKA treatment (all p-values >0.1) except F1,2 (p<0.001). High baseline TAT levels were associated with decreased cardioversion success. Conclusions: Anticoagulation with the NOAC rivaroxaban attenuated biomarkers of inflammation and key coagulation parameters to a similar extent as VKA in patients with AF, with the exception of prothrombin fragments. (Table Presented).